H.B. 29

1

INSURANCE AMENDMENTS
2 2012 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: James A. Dunnigan
5 Senate Sponsor: ____________
6
7 LONG TITLE
8 Committee Note:
9 The Business and Labor Interim Committee recommended this bill.
10 General Description:
11 This bill modifies the Insurance Code to make various changes related to the regulation
12 of insurance.
13 Highlighted Provisions:
14 This bill:
15 . modifies definition provisions;
16 . addresses catastrophic coverage of mental health conditions;
17 . amends provisions related to adverse benefit determination review process;
18 . addresses when uniform waiver of coverage forms may be combined or modified;
19 . provides for the establishment of surplus lines producers;
20 . modifies definitions related to insurance marketing and licensing;
21 . addresses what constitutes administrative action taken against a person that is to be
22 reported to the commissioner;
23 . clarifies when a line of authority no longer remains in force for a person;
24 . addresses references to the federal Violent Crime Control and Law Enforcement
25 Act;
26 . requires a person who wants to reinstate a voluntarily surrendered license to comply
27 with continuing education requirements;

28 . modifies special requirements for bail bond producers and bail bond enforcement
29 agents;
30 . addresses special requirements for variable contracts lines of authority;
31 . addresses disbursements from certain trust accounts;
32 . modifies language regarding trust obligation for certain money;
33 . addresses payments of claims by administrator;
34 . addresses commissioner's administrative actions;
35 . grants rulemaking authority to the commissioner regarding model regulations
36 related to determining hazardous financial condition of an insurer;
37 . changes dates related to coverage under a pool policy;
38 . deletes definition of basic benefit plan;
39 . addresses health benefit plan choices;
40 . grants immunity related to good faith communications between insurers or
41 employees of insurers;
42 . addresses reporting by the board of directors of the Utah Defined Contribution Risk
43 Adjuster; and
44 . makes technical and conforming amendments.
45 Money Appropriated in this Bill:
46 None
47 Other Special Clauses:
48 None
49 Utah Code Sections Affected:
50 AMENDS:
51 31A-1-301, as last amended by Laws of Utah 2011, Chapters 284 and 366
52 31A-2-308, as last amended by Laws of Utah 2009, Chapter 347
53 31A-2-404, as last amended by Laws of Utah 2010, Chapter 10
54 31A-22-625, as last amended by Laws of Utah 2011, Chapters 240, 284, 297, 366, and
55 400
56 31A-22-629, as last amended by Laws of Utah 2007, Chapter 307
57 31A-22-635, as last amended by Laws of Utah 2011, Chapter 400
58 31A-23a-101, as renumbered and amended by Laws of Utah 2003, Chapter 298

59 31A-23a-102, as last amended by Laws of Utah 2011, Chapter 284
60 31A-23a-103, as renumbered and amended by Laws of Utah 2003, Chapter 298
61 31A-23a-104, as last amended by Laws of Utah 2011, Chapter 337
62 31A-23a-105, as last amended by Laws of Utah 2011, Chapter 337
63 31A-23a-106, as last amended by Laws of Utah 2011, Chapter 284
64 31A-23a-107, as renumbered and amended by Laws of Utah 2003, Chapter 298
65 31A-23a-108, as last amended by Laws of Utah 2005, Chapters 185 and 219
66 31A-23a-109, as last amended by Laws of Utah 2008, Chapter 3
67 31A-23a-111, as last amended by Laws of Utah 2011, Chapter 284
68 31A-23a-113, as last amended by Laws of Utah 2009, Chapter 349
69 31A-23a-115.5, as enacted by Laws of Utah 2011, Chapter 400
70 31A-23a-203, as last amended by Laws of Utah 2011, Chapter 284
71 31A-23a-205, as renumbered and amended by Laws of Utah 2003, Chapter 298
72 31A-23a-206, as renumbered and amended by Laws of Utah 2003, Chapter 298
73 31A-23a-301, as enacted by Laws of Utah 2003, Chapter 298
74 31A-23a-302, as last amended by Laws of Utah 2009, Chapter 349
75 31A-23a-406, as last amended by Laws of Utah 2011, Chapter 284
76 31A-23a-409, as last amended by Laws of Utah 2011, Chapter 342
77 31A-23a-412, as last amended by Laws of Utah 2011, Chapter 284
78 31A-25-203, as last amended by Laws of Utah 2009, Chapter 349
79 31A-25-306, as enacted by Laws of Utah 1985, Chapter 242
80 31A-26-203, as last amended by Laws of Utah 2009, Chapter 349
81 31A-27-503, as renumbered and amended by Laws of Utah 2007, Chapter 309
82 31A-27a-101, as enacted by Laws of Utah 2007, Chapter 309
83 31A-29-112, as last amended by Laws of Utah 2004, Chapter 2
84 31A-30-103, as last amended by Laws of Utah 2011, Chapters 284 and 400
85 31A-30-109, as last amended by Laws of Utah 2009, Chapter 12
86 31A-30-112, as last amended by Laws of Utah 2011, Chapter 284
87 31A-31-105, as last amended by Laws of Utah 2008, Chapter 150
88 31A-41-301, as enacted by Laws of Utah 2008, Chapter 220
89 31A-42-203, as enacted by Laws of Utah 2009, Chapter 12

90
91 Be it enacted by the Legislature of the state of Utah:
92 Section 1. Section 31A-1-301 is amended to read:
93 31A-1-301. Definitions.
94 As used in this title, unless otherwise specified:
95 (1) (a) "Accident and health insurance" means insurance to provide protection against
96 economic losses resulting from:
97 (i) a medical condition including:
98 (A) a medical care expense; or
99 (B) the risk of disability;
100 (ii) accident; or
101 (iii) sickness.
102 (b) "Accident and health insurance":
103 (i) includes a contract with disability contingencies including:
104 (A) an income replacement contract;
105 (B) a health care contract;
106 (C) an expense reimbursement contract;
107 (D) a credit accident and health contract;
108 (E) a continuing care contract; and
109 (F) a long-term care contract; and
110 (ii) may provide:
111 (A) hospital coverage;
112 (B) surgical coverage;
113 (C) medical coverage;
114 (D) loss of income coverage;
115 (E) prescription drug coverage;
116 (F) dental coverage; or
117 (G) vision coverage.
118 (c) "Accident and health insurance" does not include workers' compensation insurance.
119 (2) "Actuary" is as defined by the commissioner by rule, made in accordance with Title
120 63G, Chapter 3, Utah Administrative Rulemaking Act.

121 (3) "Administrator" is defined in Subsection [(161)] (162).
122 (4) "Adult" means an individual who has attained the age of at least 18 years.
123 (5) "Affiliate" means a person who controls, is controlled by, or is under common
124 control with, another person. A corporation is an affiliate of another corporation, regardless of
125 ownership, if substantially the same group of individuals manage the corporations.
126 (6) "Agency" means:
127 (a) a person other than an individual, including a sole proprietorship by which an
128 individual does business under an assumed name; and
129 (b) an insurance organization licensed or required to be licensed under Section
130 31A-23a-301 , 31A-25-207 , or 31A-26-209 .
131 (7) "Alien insurer" means an insurer domiciled outside the United States.
132 (8) "Amendment" means an endorsement to an insurance policy or certificate.
133 (9) "Annuity" means an agreement to make periodical payments for a period certain or
134 over the lifetime of one or more individuals if the making or continuance of all or some of the
135 series of the payments, or the amount of the payment, is dependent upon the continuance of
136 human life.
137 (10) "Application" means a document:
138 (a) (i) completed by an applicant to provide information about the risk to be insured;
139 and
140 (ii) that contains information that is used by the insurer to evaluate risk and decide
141 whether to:
142 (A) insure the risk under:
143 (I) the coverage as originally offered; or
144 (II) a modification of the coverage as originally offered; or
145 (B) decline to insure the risk; or
146 (b) used by the insurer to gather information from the applicant before issuance of an
147 annuity contract.
148 (11) "Articles" or "articles of incorporation" means:
149 (a) the original articles;
150 (b) a special law;
151 (c) a charter;

152 (d) an amendment;
153 (e) restated articles;
154 (f) articles of merger or consolidation;
155 (g) a trust instrument;
156 (h) another constitutive document for a trust or other entity that is not a corporation;
157 and
158 (i) an amendment to an item listed in Subsections (11)(a) through (h).
159 (12) "Bail bond insurance" means a guarantee that a person will attend court when
160 required, up to and including surrender of the person in execution of a sentence imposed under
161 Subsection 77-20-7 (1), as a condition to the release of that person from confinement.
162 (13) "Binder" is defined in Section 31A-21-102 .
163 (14) "Blanket insurance policy" means a group policy covering a defined class of
164 persons:
165 (a) without individual underwriting or application; and
166 (b) that is determined by definition without designating each person covered.
167 (15) "Board," "board of trustees," or "board of directors" means the group of persons
168 with responsibility over, or management of, a corporation, however designated.
169 (16) "Bona fide office" means a physical office in this state:
170 (a) that is open to the public;
171 (b) that is staffed during regular business hours on regular business days; and
172 (c) at which the public may appear in person to obtain services.
173 (17) "Business entity" means:
174 (a) a corporation;
175 (b) an association;
176 (c) a partnership;
177 (d) a limited liability company;
178 (e) a limited liability partnership; or
179 (f) another legal entity.
180 (18) "Business of insurance" is defined in Subsection [(87)] (88).
181 (19) "Business plan" means the information required to be supplied to the
182 commissioner under Subsections 31A-5-204 (2)(i) and (j), including the information required

183 when these subsections apply by reference under:
184 (a) Section 31A-7-201 ;
185 (b) Section 31A-8-205 ; or
186 (c) Subsection 31A-9-205 (2).
187 (20) (a) "Bylaws" means the rules adopted for the regulation or management of a
188 corporation's affairs, however designated.
189 (b) "Bylaws" includes comparable rules for a trust or other entity that is not a
190 corporation.
191 (21) "Captive insurance company" means:
192 (a) an insurer:
193 (i) owned by another organization; and
194 (ii) whose exclusive purpose is to insure risks of the parent organization and an
195 affiliated company; or
196 (b) in the case of a group or association, an insurer:
197 (i) owned by the insureds; and
198 (ii) whose exclusive purpose is to insure risks of:
199 (A) a member organization;
200 (B) a group member; or
201 (C) an affiliate of:
202 (I) a member organization; or
203 (II) a group member.
204 (22) "Casualty insurance" means liability insurance.
205 (23) "Certificate" means evidence of insurance given to:
206 (a) an insured under a group insurance policy; or
207 (b) a third party.
208 (24) "Certificate of authority" is included within the term "license."
209 (25) "Claim," unless the context otherwise requires, means a request or demand on an
210 insurer for payment of a benefit according to the terms of an insurance policy.
211 (26) "Claims-made coverage" means an insurance contract or provision limiting
212 coverage under a policy insuring against legal liability to claims that are first made against the
213 insured while the policy is in force.

214 (27) (a) "Commissioner" or "commissioner of insurance" means Utah's insurance
215 commissioner.
216 (b) When appropriate, the terms listed in Subsection (27)(a) apply to the equivalent
217 supervisory official of another jurisdiction.
218 (28) (a) "Continuing care insurance" means insurance that:
219 (i) provides board and lodging;
220 (ii) provides one or more of the following:
221 (A) a personal service;
222 (B) a nursing service;
223 (C) a medical service; or
224 (D) any other health-related service; and
225 (iii) provides the coverage described in this Subsection (28)(a) under an agreement
226 effective:
227 (A) for the life of the insured; or
228 (B) for a period in excess of one year.
229 (b) Insurance is continuing care insurance regardless of whether or not the board and
230 lodging are provided at the same location as a service described in Subsection (28)(a)(ii).
231 (29) (a) "Control," "controlling," "controlled," or "under common control" means the
232 direct or indirect possession of the power to direct or cause the direction of the management
233 and policies of a person. This control may be:
234 (i) by contract;
235 (ii) by common management;
236 (iii) through the ownership of voting securities; or
237 (iv) by a means other than those described in Subsections (29)(a)(i) through (iii).
238 (b) There is no presumption that an individual holding an official position with another
239 person controls that person solely by reason of the position.
240 (c) A person having a contract or arrangement giving control is considered to have
241 control despite the illegality or invalidity of the contract or arrangement.
242 (d) There is a rebuttable presumption of control in a person who directly or indirectly
243 owns, controls, holds with the power to vote, or holds proxies to vote 10% or more of the
244 voting securities of another person.

245 (30) "Controlled insurer" means a licensed insurer that is either directly or indirectly
246 controlled by a producer.
247 (31) "Controlling person" means a person that directly or indirectly has the power to
248 direct or cause to be directed, the management, control, or activities of a reinsurance
249 intermediary.
250 (32) "Controlling producer" means a producer who directly or indirectly controls an
251 insurer.
252 (33) (a) "Corporation" means an insurance corporation, except when referring to:
253 (i) a corporation doing business:
254 (A) as:
255 (I) an insurance producer;
256 (II) a surplus lines producer;
257 [(II)] (III) a limited line producer;
258 [(III)] (IV) a consultant;
259 [(IV)] (V) a managing general agent;
260 [(V)] (VI) a reinsurance intermediary;
261 [(VI)] (VII) a third party administrator; or
262 [(VII)] (VIII) an adjuster; and
263 (B) under:
264 (I) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
265 Reinsurance Intermediaries;
266 (II) Chapter 25, Third Party Administrators; or
267 (III) Chapter 26, Insurance Adjusters; or
268 (ii) a noninsurer that is part of a holding company system under Chapter 16, Insurance
269 Holding Companies.
270 (b) "Stock corporation" means a stock insurance corporation.
271 (c) "Mutual" or "mutual corporation" means a mutual insurance corporation.
272 (34) (a) "Creditable coverage" has the same meaning as provided in federal regulations
273 adopted pursuant to the Health Insurance Portability and Accountability Act.
274 (b) "Creditable coverage" includes coverage that is offered through a public health plan
275 such as:

276 (i) the Primary Care Network Program under a Medicaid primary care network
277 demonstration waiver obtained subject to Section 26-18-3 ;
278 (ii) the Children's Health Insurance Program under Section 26-40-106 ; or
279 (iii) the Ryan White Program Comprehensive AIDS Resources Emergency Act, Pub. L.
280 101-381, and Ryan White HIV/AIDS Treatment Modernization Act of 2006, Pub. L. 109-415.
281 (35) "Credit accident and health insurance" means insurance on a debtor to provide
282 indemnity for payments coming due on a specific loan or other credit transaction while the
283 debtor has a disability.
284 (36) (a) "Credit insurance" means insurance offered in connection with an extension of
285 credit that is limited to partially or wholly extinguishing that credit obligation.
286 (b) "Credit insurance" includes:
287 (i) credit accident and health insurance;
288 (ii) credit life insurance;
289 (iii) credit property insurance;
290 (iv) credit unemployment insurance;
291 (v) guaranteed automobile protection insurance;
292 (vi) involuntary unemployment insurance;
293 (vii) mortgage accident and health insurance;
294 (viii) mortgage guaranty insurance; and
295 (ix) mortgage life insurance.
296 (37) "Credit life insurance" means insurance on the life of a debtor in connection with
297 an extension of credit that pays a person if the debtor dies.
298 (38) "Credit property insurance" means insurance:
299 (a) offered in connection with an extension of credit; and
300 (b) that protects the property until the debt is paid.
301 (39) "Credit unemployment insurance" means insurance:
302 (a) offered in connection with an extension of credit; and
303 (b) that provides indemnity if the debtor is unemployed for payments coming due on a:
304 (i) specific loan; or
305 (ii) credit transaction.
306 (40) "Creditor" means a person, including an insured, having a claim, whether:

307 (a) matured;
308 (b) unmatured;
309 (c) liquidated;
310 (d) unliquidated;
311 (e) secured;
312 (f) unsecured;
313 (g) absolute;
314 (h) fixed; or
315 (i) contingent.
316 (41) (a) "Crop insurance" means insurance providing protection against damage to
317 crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation,
318 disease or other yield-reducing conditions or perils that is:
319 (i) provided by the private insurance market; or
320 (ii) subsidized by the Federal Crop Insurance Corporation.
321 (b) "Crop insurance" includes multi-peril crop insurance.
322 [(41)] (42) (a) "Customer service representative" means a person that provides an
323 insurance service and insurance product information:
324 (i) for the customer service representative's:
325 (A) producer; [or]
326 (B) surplus lines producer; or
327 [(B)] (C) consultant employer; and
328 (ii) to the customer service representative's employer's:
329 (A) customer;
330 (B) client; or
331 (C) organization.
332 (b) A customer service representative may only operate within the scope of authority of
333 the customer service representative's producer, surplus lines producer, or consultant employer.
334 [(42)] (43) "Deadline" means a final date or time:
335 (a) imposed by:
336 (i) statute;
337 (ii) rule; or

338 (iii) order; and
339 (b) by which a required filing or payment must be received by the department.
340 [(43)] (44) "Deemer clause" means a provision under this title under which upon the
341 occurrence of a condition precedent, the commissioner is considered to have taken a specific
342 action. If the statute so provides, a condition precedent may be the commissioner's failure to
343 take a specific action.
344 [(44)] (45) "Degree of relationship" means the number of steps between two persons
345 determined by counting the generations separating one person from a common ancestor and
346 then counting the generations to the other person.
347 [(45)] (46) "Department" means the Insurance Department.
348 [(46)] (47) "Director" means a member of the board of directors of a corporation.
349 [(47)] (48) "Disability" means a physiological or psychological condition that partially
350 or totally limits an individual's ability to:
351 (a) perform the duties of:
352 (i) that individual's occupation; or
353 (ii) any occupation for which the individual is reasonably suited by education, training,
354 or experience; or
355 (b) perform two or more of the following basic activities of daily living:
356 (i) eating;
357 (ii) toileting;
358 (iii) transferring;
359 (iv) bathing; or
360 (v) dressing.
361 [(48)] (49) "Disability income insurance" is defined in Subsection [(78)] (79).
362 [(49)] (50) "Domestic insurer" means an insurer organized under the laws of this state.
363 [(50)] (51) "Domiciliary state" means the state in which an insurer:
364 (a) is incorporated;
365 (b) is organized; or
366 (c) in the case of an alien insurer, enters into the United States.
367 [(51)] (52) (a) "Eligible employee" means:
368 (i) an employee who:

369 (A) works on a full-time basis; and
370 (B) has a normal work week of 30 or more hours; or
371 (ii) a person described in Subsection [(51)] (52)(b).
372 (b) "Eligible employee" includes, if the individual is included under a health benefit
373 plan of a small employer:
374 (i) a sole proprietor;
375 (ii) a partner in a partnership; or
376 (iii) an independent contractor.
377 (c) "Eligible employee" does not include, unless eligible under Subsection [(51)]
378 (52)(b):
379 (i) an individual who works on a temporary or substitute basis for a small employer;
380 (ii) an employer's spouse; or
381 (iii) a dependent of an employer.
382 [(52)] (53) "Employee" means an individual employed by an employer.
383 [(53)] (54) "Employee benefits" means one or more benefits or services provided to:
384 (a) an employee; or
385 (b) a dependent of an employee.
386 [(54)] (55) (a) "Employee welfare fund" means a fund:
387 (i) established or maintained, whether directly or through a trustee, by:
388 (A) one or more employers;
389 (B) one or more labor organizations; or
390 (C) a combination of employers and labor organizations; and
391 (ii) that provides employee benefits paid or contracted to be paid, other than income
392 from investments of the fund:
393 (A) by or on behalf of an employer doing business in this state; or
394 (B) for the benefit of a person employed in this state.
395 (b) "Employee welfare fund" includes a plan funded or subsidized by a user fee or tax
396 revenues.
397 [(55)] (56) "Endorsement" means a written agreement attached to a policy or certificate
398 to modify the policy or certificate coverage.
399 [(56)] (57) "Enrollment date," with respect to a health benefit plan, means:

400 (a) the first day of coverage; or
401 (b) if there is a waiting period, the first day of the waiting period.
402 [(57)] (58) (a) "Escrow" means:
403 (i) a real estate settlement or real estate closing conducted by a third party pursuant to
404 the requirements of a written agreement between the parties in a real estate transaction; or
405 (ii) a settlement or closing involving:
406 (A) a mobile home;
407 (B) a grazing right;
408 (C) a water right; or
409 (D) other personal property authorized by the commissioner.
410 (b) "Escrow" includes the act of conducting a:
411 (i) real estate settlement; or
412 (ii) real estate closing.
413 [(58)] (59) "Escrow agent" means:
414 (a) an insurance producer with:
415 (i) a title insurance line of authority; and
416 (ii) an escrow subline of authority; or
417 (b) a person defined as an escrow agent in Section 7-22-101 .
418 [(59)] (60) (a) "Excludes" is not exhaustive and does not mean that another thing is not
419 also excluded.
420 (b) The items listed in a list using the term "excludes" are representative examples for
421 use in interpretation of this title.
422 [(60)] (61) "Exclusion" means for the purposes of accident and health insurance that an
423 insurer does not provide insurance coverage, for whatever reason, for one of the following:
424 (a) a specific physical condition;
425 (b) a specific medical procedure;
426 (c) a specific disease or disorder; or
427 (d) a specific prescription drug or class of prescription drugs.
428 [(61)] (62) "Expense reimbursement insurance" means insurance:
429 (a) written to provide a payment for an expense relating to hospital confinement
430 resulting from illness or injury; and

431 (b) written:
432 (i) as a daily limit for a specific number of days in a hospital; and
433 (ii) to have a one or two day waiting period following a hospitalization.
434 [(62)] (63) "Fidelity insurance" means insurance guaranteeing the fidelity of a person
435 holding a position of public or private trust.
436 [(63)] (64) (a) "Filed" means that a filing is:
437 (i) submitted to the department as required by and in accordance with applicable
438 statute, rule, or filing order;
439 (ii) received by the department within the time period provided in applicable statute,
440 rule, or filing order; and
441 (iii) accompanied by the appropriate fee in accordance with:
442 (A) Section 31A-3-103 ; or
443 (B) rule.
444 (b) "Filed" does not include a filing that is rejected by the department because it is not
445 submitted in accordance with Subsection [(63)] (64)(a).
446 [(64)] (65) "Filing," when used as a noun, means an item required to be filed with the
447 department including:
448 (a) a policy;
449 (b) a rate;
450 (c) a form;
451 (d) a document;
452 (e) a plan;
453 (f) a manual;
454 (g) an application;
455 (h) a report;
456 (i) a certificate;
457 (j) an endorsement;
458 (k) an actuarial certification;
459 (l) a licensee annual statement;
460 (m) a licensee renewal application;
461 (n) an advertisement; or

462 (o) an outline of coverage.
463 [(65)] (66) "First party insurance" means an insurance policy or contract in which the
464 insurer agrees to pay a claim submitted to it by the insured for the insured's losses.
465 [(66)] (67) "Foreign insurer" means an insurer domiciled outside of this state, including
466 an alien insurer.
467 [(67)] (68) (a) "Form" means one of the following prepared for general use:
468 (i) a policy;
469 (ii) a certificate;
470 (iii) an application;
471 (iv) an outline of coverage; or
472 (v) an endorsement.
473 (b) "Form" does not include a document specially prepared for use in an individual
474 case.
475 [(68)] (69) "Franchise insurance" means an individual insurance policy provided
476 through a mass marketing arrangement involving a defined class of persons related in some
477 way other than through the purchase of insurance.
478 [(69)] (70) "General lines of authority" include:
479 (a) the general lines of insurance in Subsection [(70)] (71);
480 (b) title insurance under one of the following sublines of authority:
481 (i) search, including authority to act as a title marketing representative;
482 (ii) escrow, including authority to act as a title marketing representative; and
483 (iii) title marketing representative only;
484 (c) surplus lines;
485 (d) workers' compensation; and
486 (e) any other line of insurance that the commissioner considers necessary to recognize
487 in the public interest.
488 [(70)] (71) "General lines of insurance" include:
489 (a) accident and health;
490 (b) casualty;
491 (c) life;
492 (d) personal lines;

493 (e) property; and
494 (f) variable contracts, including variable life and annuity.
495 [(71)] (72) "Group health plan" means an employee welfare benefit plan to the extent
496 that the plan provides medical care:
497 (a) (i) to an employee; or
498 (ii) to a dependent of an employee; and
499 (b) (i) directly;
500 (ii) through insurance reimbursement; or
501 (iii) through another method.
502 [(72)] (73) (a) "Group insurance policy" means a policy covering a group of persons
503 that is issued:
504 (i) to a policyholder on behalf of the group; and
505 (ii) for the benefit of a member of the group who is selected under a procedure defined
506 in:
507 (A) the policy; or
508 (B) an agreement that is collateral to the policy.
509 (b) A group insurance policy may include a member of the policyholder's family or a
510 dependent.
511 [(73)] (74) "Guaranteed automobile protection insurance" means insurance offered in
512 connection with an extension of credit that pays the difference in amount between the
513 insurance settlement and the balance of the loan if the insured automobile is a total loss.
514 [(74)] (75) (a) Except as provided in Subsection [(74)] (75)(b), "health benefit plan"
515 means a policy or certificate that:
516 (i) provides health care insurance;
517 (ii) provides major medical expense insurance; or
518 (iii) is offered as a substitute for hospital or medical expense insurance, such as:
519 (A) a hospital confinement indemnity; or
520 (B) a limited benefit plan.
521 (b) "Health benefit plan" does not include a policy or certificate that:
522 (i) provides benefits solely for:
523 (A) accident;

524 (B) dental;
525 (C) income replacement;
526 (D) long-term care;
527 (E) a Medicare supplement;
528 (F) a specified disease;
529 (G) vision; or
530 (H) a short-term limited duration; or
531 (ii) is offered and marketed as supplemental health insurance.
532 [(75)] (76) "Health care" means any of the following intended for use in the diagnosis,
533 treatment, mitigation, or prevention of a human ailment or impairment:
534 (a) a professional service;
535 (b) a personal service;
536 (c) a facility;
537 (d) equipment;
538 (e) a device;
539 (f) supplies; or
540 (g) medicine.
541 [(76)] (77) (a) "Health care insurance" or "health insurance" means insurance
542 providing:
543 (i) a health care benefit; or
544 (ii) payment of an incurred health care expense.
545 (b) "Health care insurance" or "health insurance" does not include accident and health
546 insurance providing a benefit for:
547 (i) replacement of income;
548 (ii) short-term accident;
549 (iii) fixed indemnity;
550 (iv) credit accident and health;
551 (v) supplements to liability;
552 (vi) workers' compensation;
553 (vii) automobile medical payment;
554 (viii) no-fault automobile;

555 (ix) equivalent self-insurance; or
556 (x) a type of accident and health insurance coverage that is a part of or attached to
557 another type of policy.
558 [(77)] (78) "Health Insurance Portability and Accountability Act" means the Health
559 Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936, as
560 amended.
561 [(78)] (79) "Income replacement insurance" or "disability income insurance" means
562 insurance written to provide payments to replace income lost from accident or sickness.
563 [(79)] (80) "Indemnity" means the payment of an amount to offset all or part of an
564 insured loss.
565 [(80)] (81) "Independent adjuster" means an insurance adjuster required to be licensed
566 under Section 31A-26-201 who engages in insurance adjusting as a representative of an insurer.
567 [(81)] (82) "Independently procured insurance" means insurance procured under
568 Section 31A-15-104 .
569 [(82)] (83) "Individual" means a natural person.
570 [(83)] (84) "Inland marine insurance" includes insurance covering:
571 (a) property in transit on or over land;
572 (b) property in transit over water by means other than boat or ship;
573 (c) bailee liability;
574 (d) fixed transportation property such as bridges, electric transmission systems, radio
575 and television transmission towers and tunnels; and
576 (e) personal and commercial property floaters.
577 [(84)] (85) "Insolvency" means that:
578 (a) an insurer is unable to pay its debts or meet its obligations as the debts and
579 obligations mature;
580 (b) an insurer's total adjusted capital is less than the insurer's mandatory control level
581 RBC under Subsection 31A-17-601 (8)(c); or
582 (c) an insurer is determined to be hazardous under this title.
583 [(85)] (86) (a) "Insurance" means:
584 (i) an arrangement, contract, or plan for the transfer of a risk or risks from one or more
585 persons to one or more other persons; or

586 (ii) an arrangement, contract, or plan for the distribution of a risk or risks among a
587 group of persons that includes the person seeking to distribute that person's risk.
588 (b) "Insurance" includes:
589 (i) a risk distributing arrangement providing for compensation or replacement for
590 damages or loss through the provision of a service or a benefit in kind;
591 (ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a
592 business and not as merely incidental to a business transaction; and
593 (iii) a plan in which the risk does not rest upon the person who makes an arrangement,
594 but with a class of persons who have agreed to share the risk.
595 [(86)] (87) "Insurance adjuster" means a person who directs the investigation,
596 negotiation, or settlement of a claim under an insurance policy other than life insurance or an
597 annuity, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
598 [(87)] (88) "Insurance business" or "business of insurance" includes:
599 (a) providing health care insurance by an organization that is or is required to be
600 licensed under this title;
601 (b) providing a benefit to an employee in the event of a contingency not within the
602 control of the employee, in which the employee is entitled to the benefit as a right, which
603 benefit may be provided either:
604 (i) by a single employer or by multiple employer groups; or
605 (ii) through one or more trusts, associations, or other entities;
606 (c) providing an annuity:
607 (i) including an annuity issued in return for a gift; and
608 (ii) except an annuity provided by a person specified in Subsections 31A-22-1305 (2)
609 and (3);
610 (d) providing the characteristic services of a motor club as outlined in Subsection
611 [(115)] (116);
612 (e) providing another person with insurance;
613 (f) making as insurer, guarantor, or surety, or proposing to make as insurer, guarantor,
614 or surety, a contract or policy of title insurance;
615 (g) transacting or proposing to transact any phase of title insurance, including:
616 (i) solicitation;

617 (ii) negotiation preliminary to execution;
618 (iii) execution of a contract of title insurance;
619 (iv) insuring; and
620 (v) transacting matters subsequent to the execution of the contract and arising out of
621 the contract, including reinsurance;
622 (h) transacting or proposing a life settlement; and
623 (i) doing, or proposing to do, any business in substance equivalent to Subsections
624 [(87)] (88)(a) through (h) in a manner designed to evade this title.
625 [(88)] (89) "Insurance consultant" or "consultant" means a person who:
626 (a) advises another person about insurance needs and coverages;
627 (b) is compensated by the person advised on a basis not directly related to the insurance
628 placed; and
629 (c) except as provided in Section 31A-23a-501 , is not compensated directly or
630 indirectly by an insurer or producer for advice given.
631 [(89)] (90) "Insurance holding company system" means a group of two or more
632 affiliated persons, at least one of whom is an insurer.
633 [(90)] (91) (a) "Insurance producer" or "producer" means a person licensed or required
634 to be licensed under the laws of this state to sell, solicit, or negotiate insurance.
635 (b) (i) "Producer for the insurer" means a producer who is compensated directly or
636 indirectly by an insurer for selling, soliciting, or negotiating an insurance product of that
637 insurer.
638 (ii) "Producer for the insurer" may be referred to as an "agent."
639 (c) (i) "Producer for the insured" means a producer who:
640 (A) is compensated directly and only by an insurance customer or an insured; and
641 (B) receives no compensation directly or indirectly from an insurer for selling,
642 soliciting, or negotiating an insurance product of that insurer to an insurance customer or
643 insured.
644 (ii) "Producer for the insured" may be referred to as a "broker."
645 [(91)] (92) (a) "Insured" means a person to whom or for whose benefit an insurer
646 makes a promise in an insurance policy and includes:
647 (i) a policyholder;

648 (ii) a subscriber;
649 (iii) a member; and
650 (iv) a beneficiary.
651 (b) The definition in Subsection [(91)] (92)(a):
652 (i) applies only to this title; and
653 (ii) does not define the meaning of this word as used in an insurance policy or
654 certificate.
655 [(92)] (93) (a) "Insurer" means a person doing an insurance business as a principal
656 including:
657 (i) a fraternal benefit society;
658 (ii) an issuer of a gift annuity other than an annuity specified in Subsections
659 31A-22-1305 (2) and (3);
660 (iii) a motor club;
661 (iv) an employee welfare plan; and
662 (v) a person purporting or intending to do an insurance business as a principal on that
663 person's own account.
664 (b) "Insurer" does not include a governmental entity to the extent the governmental
665 entity is engaged in an activity described in Section 31A-12-107 .
666 [(93)] (94) "Interinsurance exchange" is defined in Subsection [(144)] (145).
667 [(94)] (95) "Involuntary unemployment insurance" means insurance:
668 (a) offered in connection with an extension of credit; and
669 (b) that provides indemnity if the debtor is involuntarily unemployed for payments
670 coming due on a:
671 (i) specific loan; or
672 (ii) credit transaction.
673 [(95)] (96) "Large employer," in connection with a health benefit plan, means an
674 employer who, with respect to a calendar year and to a plan year:
675 (a) employed an average of at least 51 eligible employees on each business day during
676 the preceding calendar year; and
677 (b) employs at least two employees on the first day of the plan year.
678 [(96)] (97) "Late enrollee," with respect to an employer health benefit plan, means an

679 individual whose enrollment is a late enrollment.
680 [(97)] (98) "Late enrollment," with respect to an employer health benefit plan, means
681 enrollment of an individual other than:
682 (a) on the earliest date on which coverage can become effective for the individual
683 under the terms of the plan; or
684 (b) through special enrollment.
685 [(98)] (99) (a) Except for a retainer contract or legal assistance described in Section
686 31A-1-103 , "legal expense insurance" means insurance written to indemnify or pay for a
687 specified legal expense.
688 (b) "Legal expense insurance" includes an arrangement that creates a reasonable
689 expectation of an enforceable right.
690 (c) "Legal expense insurance" does not include the provision of, or reimbursement for,
691 legal services incidental to other insurance coverage.
692 [(99)] (100) (a) "Liability insurance" means insurance against liability:
693 (i) for death, injury, or disability of a human being, or for damage to property,
694 exclusive of the coverages under:
695 (A) Subsection [(109)] (110) for medical malpractice insurance;
696 (B) Subsection [(136)] (137) for professional liability insurance; and
697 (C) Subsection [(170)] (171) for workers' compensation insurance;
698 (ii) for a medical, hospital, surgical, and funeral benefit to a person other than the
699 insured who is injured, irrespective of legal liability of the insured, when issued with or
700 supplemental to insurance against legal liability for the death, injury, or disability of a human
701 being, exclusive of the coverages under:
702 (A) Subsection [(109)] (110) for medical malpractice insurance;
703 (B) Subsection [(136)] (137) for professional liability insurance; and
704 (C) Subsection [(170)] (171) for workers' compensation insurance;
705 (iii) for loss or damage to property resulting from an accident to or explosion of a
706 boiler, pipe, pressure container, machinery, or apparatus;
707 (iv) for loss or damage to property caused by:
708 (A) the breakage or leakage of a sprinkler, water pipe, or water container; or
709 (B) water entering through a leak or opening in a building; or

710 (v) for other loss or damage properly the subject of insurance not within another kind
711 of insurance as defined in this chapter, if the insurance is not contrary to law or public policy.
712 (b) "Liability insurance" includes:
713 (i) vehicle liability insurance;
714 (ii) residential dwelling liability insurance; and
715 (iii) making inspection of, and issuing a certificate of inspection upon, an elevator,
716 boiler, machinery, or apparatus of any kind when done in connection with insurance on the
717 elevator, boiler, machinery, or apparatus.
718 [(100)] (101) (a) "License" means authorization issued by the commissioner to engage
719 in an activity that is part of or related to the insurance business.
720 (b) "License" includes a certificate of authority issued to an insurer.
721 [(101)] (102) (a) "Life insurance" means:
722 (i) insurance on a human life; and
723 (ii) insurance pertaining to or connected with human life.
724 (b) The business of life insurance includes:
725 (i) granting a death benefit;
726 (ii) granting an annuity benefit;
727 (iii) granting an endowment benefit;
728 (iv) granting an additional benefit in the event of death by accident;
729 (v) granting an additional benefit to safeguard the policy against lapse; and
730 (vi) providing an optional method of settlement of proceeds.
731 [(102)] (103) "Limited license" means a license that:
732 (a) is issued for a specific product of insurance; and
733 (b) limits an individual or agency to transact only for that product or insurance.
734 [(103)] (104) "Limited line credit insurance" includes the following forms of
735 insurance:
736 (a) credit life;
737 (b) credit accident and health;
738 (c) credit property;
739 (d) credit unemployment;
740 (e) involuntary unemployment;

741 (f) mortgage life;
742 (g) mortgage guaranty;
743 (h) mortgage accident and health;
744 (i) guaranteed automobile protection; and
745 (j) another form of insurance offered in connection with an extension of credit that:
746 (i) is limited to partially or wholly extinguishing the credit obligation; and
747 (ii) the commissioner determines by rule should be designated as a form of limited line
748 credit insurance.
749 [(104)] (105) "Limited line credit insurance producer" means a person who sells,
750 solicits, or negotiates one or more forms of limited line credit insurance coverage to an
751 individual through a master, corporate, group, or individual policy.
752 [(105)] (106) "Limited line insurance" includes:
753 (a) bail bond;
754 (b) limited line credit insurance;
755 (c) legal expense insurance;
756 (d) motor club insurance;
757 (e) car rental related insurance;
758 (f) travel insurance;
759 (g) crop insurance;
760 (h) self-service storage insurance;
761 (i) guaranteed asset protection waiver; and
762 (j) another form of limited insurance that the commissioner determines by rule should
763 be designated a form of limited line insurance.
764 [(106)] (107) "Limited lines authority" includes:
765 (a) the lines of insurance listed in Subsection [(105)] (106); and
766 (b) a customer service representative.
767 [(107)] (108) "Limited lines producer" means a person who sells, solicits, or negotiates
768 limited lines insurance.
769 [(108)] (109) (a) "Long-term care insurance" means an insurance policy or rider
770 advertised, marketed, offered, or designated to provide coverage:
771 (i) in a setting other than an acute care unit of a hospital;

772 (ii) for not less than 12 consecutive months for a covered person on the basis of:
773 (A) expenses incurred;
774 (B) indemnity;
775 (C) prepayment; or
776 (D) another method;
777 (iii) for one or more necessary or medically necessary services that are:
778 (A) diagnostic;
779 (B) preventative;
780 (C) therapeutic;
781 (D) rehabilitative;
782 (E) maintenance; or
783 (F) personal care; and
784 (iv) that may be issued by:
785 (A) an insurer;
786 (B) a fraternal benefit society;
787 (C) (I) a nonprofit health hospital; and
788 (II) a medical service corporation;
789 (D) a prepaid health plan;
790 (E) a health maintenance organization; or
791 (F) an entity similar to the entities described in Subsections [(108)] (109)(a)(iv)(A)
792 through (E) to the extent that the entity is otherwise authorized to issue life or health care
793 insurance.
794 (b) "Long-term care insurance" includes:
795 (i) any of the following that provide directly or supplement long-term care insurance:
796 (A) a group or individual annuity or rider; or
797 (B) a life insurance policy or rider;
798 (ii) a policy or rider that provides for payment of benefits on the basis of:
799 (A) cognitive impairment; or
800 (B) functional capacity; or
801 (iii) a qualified long-term care insurance contract.
802 (c) "Long-term care insurance" does not include:

803 (i) a policy that is offered primarily to provide basic Medicare supplement coverage;
804 (ii) basic hospital expense coverage;
805 (iii) basic medical/surgical expense coverage;
806 (iv) hospital confinement indemnity coverage;
807 (v) major medical expense coverage;
808 (vi) income replacement or related asset-protection coverage;
809 (vii) accident only coverage;
810 (viii) coverage for a specified:
811 (A) disease; or
812 (B) accident;
813 (ix) limited benefit health coverage; or
814 (x) a life insurance policy that accelerates the death benefit to provide the option of a
815 lump sum payment:
816 (A) if the following are not conditioned on the receipt of long-term care:
817 (I) benefits; or
818 (II) eligibility; and
819 (B) the coverage is for one or more the following qualifying events:
820 (I) terminal illness;
821 (II) medical conditions requiring extraordinary medical intervention; or
822 (III) permanent institutional confinement.
823 [(109)] (110) "Medical malpractice insurance" means insurance against legal liability
824 incident to the practice and provision of a medical service other than the practice and provision
825 of a dental service.
826 [(110)] (111) "Member" means a person having membership rights in an insurance
827 corporation.
828 [(111)] (112) "Minimum capital" or "minimum required capital" means the capital that
829 must be constantly maintained by a stock insurance corporation as required by statute.
830 [(112)] (113) "Mortgage accident and health insurance" means insurance offered in
831 connection with an extension of credit that provides indemnity for payments coming due on a
832 mortgage while the debtor has a disability.
833 [(113)] (114) "Mortgage guaranty insurance" means surety insurance under which a

834 mortgagee or other creditor is indemnified against losses caused by the default of a debtor.
835 [(114)] (115) "Mortgage life insurance" means insurance on the life of a debtor in
836 connection with an extension of credit that pays if the debtor dies.
837 [(115)] (116) "Motor club" means a person:
838 (a) licensed under:
839 (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
840 (ii) Chapter 11, Motor Clubs; or
841 (iii) Chapter 14, Foreign Insurers; and
842 (b) that promises for an advance consideration to provide for a stated period of time
843 one or more:
844 (i) legal services under Subsection 31A-11-102 (1)(b);
845 (ii) bail services under Subsection 31A-11-102 (1)(c); or
846 (iii) (A) trip reimbursement;
847 (B) towing services;
848 (C) emergency road services;
849 (D) stolen automobile services;
850 (E) a combination of the services listed in Subsections [(115)] (116)(b)(iii)(A) through
851 (D); or
852 (F) other services given in Subsections 31A-11-102 (1)(b) through (f).
853 [(116)] (117) "Mutual" means a mutual insurance corporation.
854 [(117)] (118) "Network plan" means health care insurance:
855 (a) that is issued by an insurer; and
856 (b) under which the financing and delivery of medical care is provided, in whole or in
857 part, through a defined set of providers under contract with the insurer, including the financing
858 and delivery of an item paid for as medical care.
859 [(118)] (119) "Nonparticipating" means a plan of insurance under which the insured is
860 not entitled to receive a dividend representing a share of the surplus of the insurer.
861 [(119)] (120) "Ocean marine insurance" means insurance against loss of or damage to:
862 (a) ships or hulls of ships;
863 (b) goods, freight, cargoes, merchandise, effects, disbursements, profits, money,
864 securities, choses in action, evidences of debt, valuable papers, bottomry, respondentia

865 interests, or other cargoes in or awaiting transit over the oceans or inland waterways;
866 (c) earnings such as freight, passage money, commissions, or profits derived from
867 transporting goods or people upon or across the oceans or inland waterways; or
868 (d) a vessel owner or operator as a result of liability to employees, passengers, bailors,
869 owners of other vessels, owners of fixed objects, customs or other authorities, or other persons
870 in connection with maritime activity.
871 [(120)] (121) "Order" means an order of the commissioner.
872 [(121)] (122) "Outline of coverage" means a summary that explains an accident and
873 health insurance policy.
874 [(122)] (123) "Participating" means a plan of insurance under which the insured is
875 entitled to receive a dividend representing a share of the surplus of the insurer.
876 [(123)] (124) "Participation," as used in a health benefit plan, means a requirement
877 relating to the minimum percentage of eligible employees that must be enrolled in relation to
878 the total number of eligible employees of an employer reduced by each eligible employee who
879 voluntarily declines coverage under the plan because the employee:
880 (a) has other group health care insurance coverage; or
881 (b) receives:
882 (i) Medicare, under the Health Insurance for the Aged Act, Title XVIII of the Social
883 Security Amendments of 1965; or
884 (ii) another government health benefit.
885 [(124)] (125) "Person" includes:
886 (a) an individual;
887 (b) a partnership;
888 (c) a corporation;
889 (d) an incorporated or unincorporated association;
890 (e) a joint stock company;
891 (f) a trust;
892 (g) a limited liability company;
893 (h) a reciprocal;
894 (i) a syndicate; or
895 (j) another similar entity or combination of entities acting in concert.

896 [(125)] (126) "Personal lines insurance" means property and casualty insurance
897 coverage sold for primarily noncommercial purposes to:
898 (a) an individual; or
899 (b) a family.
900 [(126)] (127) "Plan sponsor" is as defined in 29 U.S.C. Sec. 1002(16)(B).
901 [(127)] (128) "Plan year" means:
902 (a) the year that is designated as the plan year in:
903 (i) the plan document of a group health plan; or
904 (ii) a summary plan description of a group health plan;
905 (b) if the plan document or summary plan description does not designate a plan year or
906 there is no plan document or summary plan description:
907 (i) the year used to determine deductibles or limits;
908 (ii) the policy year, if the plan does not impose deductibles or limits on a yearly basis;
909 or
910 (iii) the employer's taxable year if:
911 (A) the plan does not impose deductibles or limits on a yearly basis; and
912 (B) (I) the plan is not insured; or
913 (II) the insurance policy is not renewed on an annual basis; or
914 (c) in a case not described in Subsection [(127)] (128)(a) or (b), the calendar year.
915 [(128)] (129) (a) "Policy" means a document, including an attached endorsement or
916 application that:
917 (i) purports to be an enforceable contract; and
918 (ii) memorializes in writing some or all of the terms of an insurance contract.
919 (b) "Policy" includes a service contract issued by:
920 (i) a motor club under Chapter 11, Motor Clubs;
921 (ii) a service contract provided under Chapter 6a, Service Contracts; and
922 (iii) a corporation licensed under:
923 (A) Chapter 7, Nonprofit Health Service Insurance Corporations; or
924 (B) Chapter 8, Health Maintenance Organizations and Limited Health Plans.
925 (c) "Policy" does not include:
926 (i) a certificate under a group insurance contract; or

927 (ii) a document that does not purport to have legal effect.
928 [(129)] (130) "Policyholder" means a person who controls a policy, binder, or oral
929 contract by ownership, premium payment, or otherwise.
930 [(130)] (131) "Policy illustration" means a presentation or depiction that includes
931 nonguaranteed elements of a policy of life insurance over a period of years.
932 [(131)] (132) "Policy summary" means a synopsis describing the elements of a life
933 insurance policy.
934 [(132)] (133) "Preexisting condition," with respect to a health benefit plan:
935 (a) means a condition that was present before the effective date of coverage, whether or
936 not medical advice, diagnosis, care, or treatment was recommended or received before that day;
937 and
938 (b) does not include a condition indicated by genetic information unless an actual
939 diagnosis of the condition by a physician has been made.
940 [(133)] (134) (a) "Premium" means the monetary consideration for an insurance policy.
941 (b) "Premium" includes, however designated:
942 (i) an assessment;
943 (ii) a membership fee;
944 (iii) a required contribution; or
945 (iv) monetary consideration.
946 (c) (i) "Premium" does not include consideration paid to a third party administrator for
947 the third party administrator's services.
948 (ii) "Premium" includes an amount paid by a third party administrator to an insurer for
949 insurance on the risks administered by the third party administrator.
950 [(134)] (135) "Principal officers" for a corporation means the officers designated under
951 Subsection 31A-5-203 (3).
952 [(135)] (136) "Proceeding" includes an action or special statutory proceeding.
953 [(136)] (137) "Professional liability insurance" means insurance against legal liability
954 incident to the practice of a profession and provision of a professional service.
955 [(137)] (138) (a) Except as provided in Subsection [(137)] (138)(b), "property
956 insurance" means insurance against loss or damage to real or personal property of every kind
957 and any interest in that property:

958 (i) from all hazards or causes; and
959 (ii) against loss consequential upon the loss or damage including vehicle
960 comprehensive and vehicle physical damage coverages.
961 (b) "Property insurance" does not include:
962 (i) inland marine insurance; and
963 (ii) ocean marine insurance.
964 [(138)] (139) "Qualified long-term care insurance contract" or "federally tax qualified
965 long-term care insurance contract" means:
966 (a) an individual or group insurance contract that meets the requirements of Section
967 7702B(b), Internal Revenue Code; or
968 (b) the portion of a life insurance contract that provides long-term care insurance:
969 (i) (A) by rider; or
970 (B) as a part of the contract; and
971 (ii) that satisfies the requirements of Sections 7702B(b) and (e), Internal Revenue
972 Code.
973 [(139)] (140) "Qualified United States financial institution" means an institution that:
974 (a) is:
975 (i) organized under the laws of the United States or any state; or
976 (ii) in the case of a United States office of a foreign banking organization, licensed
977 under the laws of the United States or any state;
978 (b) is regulated, supervised, and examined by a United States federal or state authority
979 having regulatory authority over a bank or trust company; and
980 (c) meets the standards of financial condition and standing that are considered
981 necessary and appropriate to regulate the quality of a financial institution whose letters of credit
982 will be acceptable to the commissioner as determined by:
983 (i) the commissioner by rule; or
984 (ii) the Securities Valuation Office of the National Association of Insurance
985 Commissioners.
986 [(140)] (141) (a) "Rate" means:
987 (i) the cost of a given unit of insurance; or
988 (ii) for property or casualty insurance, that cost of insurance per exposure unit either

989 expressed as:
990 (A) a single number; or
991 (B) a pure premium rate, adjusted before the application of individual risk variations
992 based on loss or expense considerations to account for the treatment of:
993 (I) expenses;
994 (II) profit; and
995 (III) individual insurer variation in loss experience.
996 (b) "Rate" does not include a minimum premium.
997 [(141)] (142) (a) Except as provided in Subsection [(141)] (142)(b), "rate service
998 organization" means a person who assists an insurer in rate making or filing by:
999 (i) collecting, compiling, and furnishing loss or expense statistics;
1000 (ii) recommending, making, or filing rates or supplementary rate information; or
1001 (iii) advising about rate questions, except as an attorney giving legal advice.
1002 (b) "Rate service organization" does not mean:
1003 (i) an employee of an insurer;
1004 (ii) a single insurer or group of insurers under common control;
1005 (iii) a joint underwriting group; or
1006 (iv) an individual serving as an actuarial or legal consultant.
1007 [(142)] (143) "Rating manual" means any of the following used to determine initial and
1008 renewal policy premiums:
1009 (a) a manual of rates;
1010 (b) a classification;
1011 (c) a rate-related underwriting rule; and
1012 (d) a rating formula that describes steps, policies, and procedures for determining
1013 initial and renewal policy premiums.
1014 [(143)] (144) "Received by the department" means:
1015 (a) the date delivered to and stamped received by the department, if delivered in
1016 person;
1017 (b) the post mark date, if delivered by mail;
1018 (c) the delivery service's post mark or pickup date, if delivered by a delivery service;
1019 (d) the received date recorded on an item delivered, if delivered by:

1020 (i) facsimile;
1021 (ii) email; or
1022 (iii) another electronic method; or
1023 (e) a date specified in:
1024 (i) a statute;
1025 (ii) a rule; or
1026 (iii) an order.
1027 [(144)] (145) "Reciprocal" or "interinsurance exchange" means an unincorporated
1028 association of persons:
1029 (a) operating through an attorney-in-fact common to all of the persons; and
1030 (b) exchanging insurance contracts with one another that provide insurance coverage
1031 on each other.
1032 [(145)] (146) "Reinsurance" means an insurance transaction where an insurer, for
1033 consideration, transfers any portion of the risk it has assumed to another insurer. In referring to
1034 reinsurance transactions, this title sometimes refers to:
1035 (a) the insurer transferring the risk as the "ceding insurer"; and
1036 (b) the insurer assuming the risk as the:
1037 (i) "assuming insurer"; or
1038 (ii) "assuming reinsurer."
1039 [(146)] (147) "Reinsurer" means a person licensed in this state as an insurer with the
1040 authority to assume reinsurance.
1041 [(147)] (148) "Residential dwelling liability insurance" means insurance against
1042 liability resulting from or incident to the ownership, maintenance, or use of a residential
1043 dwelling that is a detached single family residence or multifamily residence up to four units.
1044 [(148)] (149) (a) "Retrocession" means reinsurance with another insurer of a liability
1045 assumed under a reinsurance contract.
1046 (b) A reinsurer "retrocedes" when the reinsurer reinsures with another insurer part of a
1047 liability assumed under a reinsurance contract.
1048 [(149)] (150) "Rider" means an endorsement to:
1049 (a) an insurance policy; or
1050 (b) an insurance certificate.

1051 [(150)] (151) (a) "Security" means a:
1052 (i) note;
1053 (ii) stock;
1054 (iii) bond;
1055 (iv) debenture;
1056 (v) evidence of indebtedness;
1057 (vi) certificate of interest or participation in a profit-sharing agreement;
1058 (vii) collateral-trust certificate;
1059 (viii) preorganization certificate or subscription;
1060 (ix) transferable share;
1061 (x) investment contract;
1062 (xi) voting trust certificate;
1063 (xii) certificate of deposit for a security;
1064 (xiii) certificate of interest of participation in an oil, gas, or mining title or lease or in
1065 payments out of production under such a title or lease;
1066 (xiv) commodity contract or commodity option;
1067 (xv) certificate of interest or participation in, temporary or interim certificate for,
1068 receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed
1069 in Subsections [(150)] (151)(a)(i) through (xiv); or
1070 (xvi) another interest or instrument commonly known as a security.
1071 (b) "Security" does not include:
1072 (i) any of the following under which an insurance company promises to pay money in a
1073 specific lump sum or periodically for life or some other specified period:
1074 (A) insurance;
1075 (B) an endowment policy; or
1076 (C) an annuity contract; or
1077 (ii) a burial certificate or burial contract.
1078 [(151)] (152) "Secondary medical condition" means a complication related to an
1079 exclusion from coverage in accident and health insurance.
1080 [(152)] (153) (a) "Self-insurance" means an arrangement under which a person
1081 provides for spreading its own risks by a systematic plan.

1082 (b) Except as provided in this Subsection [(152)] (153), "self-insurance" does not
1083 include an arrangement under which a number of persons spread their risks among themselves.
1084 (c) "Self-insurance" includes:
1085 (i) an arrangement by which a governmental entity undertakes to indemnify an
1086 employee for liability arising out of the employee's employment; and
1087 (ii) an arrangement by which a person with a managed program of self-insurance and
1088 risk management undertakes to indemnify its affiliates, subsidiaries, directors, officers, or
1089 employees for liability or risk that is related to the relationship or employment.
1090 (d) "Self-insurance" does not include an arrangement with an independent contractor.
1091 [(153)] (154) "Sell" means to exchange a contract of insurance:
1092 (a) by any means;
1093 (b) for money or its equivalent; and
1094 (c) on behalf of an insurance company.
1095 [(154)] (155) "Short-term care insurance" means an insurance policy or rider
1096 advertised, marketed, offered, or designed to provide coverage that is similar to long-term care
1097 insurance, but that provides coverage for less than 12 consecutive months for each covered
1098 person.
1099 [(155)] (156) "Significant break in coverage" means a period of 63 consecutive days
1100 during each of which an individual does not have creditable coverage.
1101 [(156)] (157) "Small employer," in connection with a health benefit plan, means an
1102 employer who, with respect to a calendar year and to a plan year:
1103 (a) employed an average of at least two employees but not more than 50 eligible
1104 employees on each business day during the preceding calendar year; and
1105 (b) employs at least two employees on the first day of the plan year.
1106 [(157)] (158) "Special enrollment period," in connection with a health benefit plan, has
1107 the same meaning as provided in federal regulations adopted pursuant to the Health Insurance
1108 Portability and Accountability Act.
1109 [(158)] (159) (a) "Subsidiary" of a person means an affiliate controlled by that person
1110 either directly or indirectly through one or more affiliates or intermediaries.
1111 (b) "Wholly owned subsidiary" of a person is a subsidiary of which all of the voting
1112 shares are owned by that person either alone or with its affiliates, except for the minimum

1113 number of shares the law of the subsidiary's domicile requires to be owned by directors or
1114 others.
1115 [(159)] (160) Subject to Subsection [(85)] (86)(b), "surety insurance" includes:
1116 (a) a guarantee against loss or damage resulting from the failure of a principal to pay or
1117 perform the principal's obligations to a creditor or other obligee;
1118 (b) bail bond insurance; and
1119 (c) fidelity insurance.
1120 [(160)] (161) (a) "Surplus" means the excess of assets over the sum of paid-in capital
1121 and liabilities.
1122 (b) (i) "Permanent surplus" means the surplus of a mutual insurer that is designated by
1123 the insurer as permanent.
1124 (ii) Sections 31A-5-211 , 31A-7-201 , 31A-8-209 , 31A-9-209 , and 31A-14-209 require
1125 that mutuals doing business in this state maintain specified minimum levels of permanent
1126 surplus.
1127 (iii) Except for assessable mutuals, the minimum permanent surplus requirement is the
1128 same as the minimum required capital requirement that applies to stock insurers.
1129 (c) "Excess surplus" means:
1130 (i) for a life insurer, accident and health insurer, health organization, or property and
1131 casualty insurer as defined in Section 31A-17-601 , the lesser of:
1132 (A) that amount of an insurer's or health organization's total adjusted capital that
1133 exceeds the product of:
1134 (I) 2.5; and
1135 (II) the sum of the insurer's or health organization's minimum capital or permanent
1136 surplus required under Section 31A-5-211 , 31A-9-209 , or 31A-14-205 ; or
1137 (B) that amount of an insurer's or health organization's total adjusted capital that
1138 exceeds the product of:
1139 (I) 3.0; and
1140 (II) the authorized control level RBC as defined in Subsection 31A-17-601 (8)(a); and
1141 (ii) for a monoline mortgage guaranty insurer, financial guaranty insurer, or title insurer
1142 that amount of an insurer's paid-in-capital and surplus that exceeds the product of:
1143 (A) 1.5; and

1144 (B) the insurer's total adjusted capital required by Subsection 31A-17-609 (1).
1145 [(161)] (162) "Third party administrator" or "administrator" means a person who
1146 collects charges or premiums from, or who, for consideration, adjusts or settles claims of
1147 residents of the state in connection with insurance coverage, annuities, or service insurance
1148 coverage, except:
1149 (a) a union on behalf of its members;
1150 (b) a person administering a:
1151 (i) pension plan subject to the federal Employee Retirement Income Security Act of
1152 1974;
1153 (ii) governmental plan as defined in Section 414(d), Internal Revenue Code; or
1154 (iii) nonelecting church plan as described in Section 410(d), Internal Revenue Code;
1155 (c) an employer on behalf of the employer's employees or the employees of one or
1156 more of the subsidiary or affiliated corporations of the employer;
1157 (d) an insurer licensed under the following, but only for a line of insurance for which
1158 the insurer holds a license in this state:
1159 (i) Chapter 5, Domestic Stock and Mutual Insurance Corporations;
1160 (ii) Chapter 7, Nonprofit Health Service Insurance Corporations;
1161 (iii) Chapter 8, Health Maintenance Organizations and Limited Health Plans;
1162 (iv) Chapter 9, Insurance Fraternals; or
1163 (v) Chapter 14, Foreign Insurers; or
1164 (e) a person:
1165 (i) licensed or exempt from licensing under:
1166 (A) Chapter 23a, Insurance Marketing - Licensing Producers, Consultants, and
1167 Reinsurance Intermediaries; or
1168 (B) Chapter 26, Insurance Adjusters; and
1169 (ii) whose activities are limited to those authorized under the license the person holds
1170 or for which the person is exempt.
1171 [(162)] (163) "Title insurance" means the insuring, guaranteeing, or indemnifying of an
1172 owner of real or personal property or the holder of liens or encumbrances on that property, or
1173 others interested in the property against loss or damage suffered by reason of liens or
1174 encumbrances upon, defects in, or the unmarketability of the title to the property, or invalidity

1175 or unenforceability of any liens or encumbrances on the property.
1176 [(163)] (164) "Total adjusted capital" means the sum of an insurer's or health
1177 organization's statutory capital and surplus as determined in accordance with:
1178 (a) the statutory accounting applicable to the annual financial statements required to be
1179 filed under Section 31A-4-113 ; and
1180 (b) another item provided by the RBC instructions, as RBC instructions is defined in
1181 Section 31A-17-601 .
1182 [(164)] (165) (a) "Trustee" means "director" when referring to the board of directors of
1183 a corporation.
1184 (b) "Trustee," when used in reference to an employee welfare fund, means an
1185 individual, firm, association, organization, joint stock company, or corporation, whether acting
1186 individually or jointly and whether designated by that name or any other, that is charged with
1187 or has the overall management of an employee welfare fund.
1188 [(165)] (166) (a) "Unauthorized insurer," "unadmitted insurer," or "nonadmitted
1189 insurer" means an insurer:
1190 (i) not holding a valid certificate of authority to do an insurance business in this state;
1191 or
1192 (ii) transacting business not authorized by a valid certificate.
1193 (b) "Admitted insurer" or "authorized insurer" means an insurer:
1194 (i) holding a valid certificate of authority to do an insurance business in this state; and
1195 (ii) transacting business as authorized by a valid certificate.
1196 [(166)] (167) "Underwrite" means the authority to accept or reject risk on behalf of the
1197 insurer.
1198 [(167)] (168) "Vehicle liability insurance" means insurance against liability resulting
1199 from or incident to ownership, maintenance, or use of a land vehicle or aircraft, exclusive of a
1200 vehicle comprehensive or vehicle physical damage coverage under Subsection [(137)] (138).
1201 [(168)] (169) "Voting security" means a security with voting rights, and includes a
1202 security convertible into a security with a voting right associated with the security.
1203 [(169)] (170) "Waiting period" for a health benefit plan means the period that must
1204 pass before coverage for an individual, who is otherwise eligible to enroll under the terms of
1205 the health benefit plan, can become effective.

1206 [(170)] (171) "Workers' compensation insurance" means:
1207 (a) insurance for indemnification of an employer against liability for compensation
1208 based on:
1209 (i) a compensable accidental injury; and
1210 (ii) occupational disease disability;
1211 (b) employer's liability insurance incidental to workers' compensation insurance and
1212 written in connection with workers' compensation insurance; and
1213 (c) insurance assuring to a person entitled to workers' compensation benefits the
1214 compensation provided by law.
1215 Section 2. Section 31A-2-308 is amended to read:
1216 31A-2-308. Enforcement penalties and procedures.
1217 (1) (a) A person who violates any insurance statute or rule or any order issued under
1218 Subsection 31A-2-201 (4) shall forfeit to the state twice the amount of any profit gained from
1219 the violation, in addition to any other forfeiture or penalty imposed.
1220 (b) (i) The commissioner may order an individual producer, surplus line producer,
1221 limited line producer, customer service representative, managing general agent, reinsurance
1222 intermediary, adjuster, or insurance consultant who violates an insurance statute or rule to
1223 forfeit to the state not more than $2,500 for each violation.
1224 (ii) The commissioner may order any other person who violates an insurance statute or
1225 rule to forfeit to the state not more than $5,000 for each violation.
1226 (c) (i) The commissioner may order an individual producer, surplus line producer,
1227 limited line producer, customer service representative, managing general agent, reinsurance
1228 intermediary, adjuster, or insurance consultant who violates an order issued under Subsection
1229 31A-2-201 (4) to forfeit to the state not more than $2,500 for each violation. Each day the
1230 violation continues is a separate violation.
1231 (ii) The commissioner may order any other person who violates an order issued under
1232 Subsection 31A-2-201 (4) to forfeit to the state not more than $5,000 for each violation. Each
1233 day the violation continues is a separate violation.
1234 (d) The commissioner may accept or compromise any forfeiture under this Subsection
1235 (1) until after a complaint is filed under Subsection (2). After the filing of the complaint, only
1236 the attorney general may compromise the forfeiture.

1237 (2) When a person fails to comply with an order issued under Subsection
1238 31A-2-201 (4), including a forfeiture order, the commissioner may file an action in any court of
1239 competent jurisdiction or obtain a court order or judgment:
1240 (a) enforcing the commissioner's order;
1241 (b) (i) directing compliance with the commissioner's order and restraining further
1242 violation of the order; and
1243 (ii) subjecting the person ordered to the procedures and sanctions available to the court
1244 for punishing contempt if the failure to comply continues; or
1245 (c) imposing a forfeiture in an amount the court considers just, up to $10,000 for each
1246 day the failure to comply continues after the filing of the complaint until judgment is rendered.
1247 (3) (a) The Utah Rules of Civil Procedure govern actions brought under Subsection (2),
1248 except that the commissioner may file a complaint seeking a court-ordered forfeiture under
1249 Subsection (2)(c) no sooner than two weeks after giving written notice of the commissioner's
1250 intention to proceed under Subsection (2)(c).
1251 (b) The commissioner's order issued under Subsection 31A-2-201 (4) may contain a
1252 notice of intention to seek a court-ordered forfeiture if the commissioner's order is disobeyed.
1253 (4) If, after a court order is issued under Subsection (2), the person fails to comply with
1254 the commissioner's order or judgment:
1255 (a) the commissioner may certify the fact of the failure to the court by affidavit; and
1256 (b) the court may, after a hearing following at least five days written notice to the
1257 parties subject to the order or judgment, amend the order or judgment to add the forfeiture or
1258 forfeitures, as prescribed in Subsection (2)(c), until the person complies.
1259 (5) (a) The proceeds of [all] the forfeitures under this section, including collection
1260 expenses, shall be paid into the General Fund.
1261 (b) The expenses of collection shall be credited to the department's budget.
1262 (c) The attorney general's budget shall be credited to the extent the department
1263 reimburses the attorney general's office for its collection expenses under this section.
1264 (6) (a) Forfeitures and judgments under this section bear interest at the rate charged by
1265 the United States Internal Revenue Service for past due taxes on the:
1266 (i) date of entry of the commissioner's order under Subsection (1); or
1267 (ii) date of judgment under Subsection (2).

1268 (b) Interest accrues from the later of the dates described in Subsection (6)(a) until the
1269 forfeiture and accrued interest are fully paid.
1270 (7) A forfeiture may not be imposed under Subsection (2)(c) if:
1271 (a) at the time the forfeiture action is commenced, the person was in compliance with
1272 the commissioner's order; or
1273 (b) the violation of the order occurred during the order's suspension.
1274 (8) The commissioner may seek an injunction as an alternative to issuing an order
1275 under Subsection 31A-2-201 (4).
1276 (9) (a) A person is guilty of a class B misdemeanor if that person:
1277 (i) intentionally violates:
1278 (A) an insurance statute of this state; or
1279 (B) an order issued under Subsection 31A-2-201 (4);
1280 (ii) intentionally permits a person over whom that person has authority to violate:
1281 (A) an insurance statute of this state; or
1282 (B) an order issued under Subsection 31A-2-201 (4); or
1283 (iii) intentionally aids any person in violating:
1284 (A) an insurance statute of this state; or
1285 (B) an order issued under Subsection 31A-2-201 (4).
1286 (b) Unless a specific criminal penalty is provided elsewhere in this title, the person may
1287 be fined not more than:
1288 (i) $10,000 if a corporation; or
1289 (ii) $5,000 if a person other than a corporation.
1290 (c) If the person is an individual, the person may, in addition, be imprisoned for up to
1291 one year.
1292 (d) As used in this Subsection (9), "intentionally" has the same meaning as under
1293 Subsection 76-2-103 (1).
1294 (10) (a) A person who knowingly and intentionally violates Section 31A-4-102 ,
1295 31A-8a-208 , 31A-15-105 , 31A-23a-116 , or 31A-31-111 is guilty of a felony as provided in this
1296 Subsection (10).
1297 (b) When the value of the property, money, or other things obtained or sought to be
1298 obtained in violation of Subsection (10)(a):

1299 (i) is less than $5,000, a person is guilty of a third degree felony; or
1300 (ii) is or exceeds $5,000, a person is guilty of a second degree felony.
1301 (11) (a) After a hearing, the commissioner may, in whole or in part, revoke, suspend,
1302 place on probation, limit, or refuse to renew the licensee's license or certificate of authority:
1303 (i) when a licensee of the department, other than a domestic insurer:
1304 (A) persistently or substantially violates the insurance law; or
1305 (B) violates an order of the commissioner under Subsection 31A-2-201 (4);
1306 (ii) if there are grounds for delinquency proceedings against the licensee under Section
1307 31A-27a-207 ; or
1308 (iii) if the licensee's methods and practices in the conduct of the licensee's business
1309 endanger, or the licensee's financial resources are inadequate to safeguard, the legitimate
1310 interests of the licensee's customers and the public.
1311 (b) Additional license termination or probation provisions for licensees other than
1312 insurers are set forth in Sections 31A-19a-303 , 31A-19a-304 , 31A-23a-111 , 31A-23a-112 ,
1313 31A-25-208 , 31A-25-209 , 31A-26-213 , 31A-26-214 , 31A-35-501 , and 31A-35-503 .
1314 (12) The enforcement penalties and procedures set forth in this section are not
1315 exclusive, but are cumulative of other rights and remedies the commissioner has pursuant to
1316 applicable law.
1317 Section 3. Section 31A-2-404 is amended to read:
1318 31A-2-404. Duties of the commissioner and Title and Escrow Commission.
1319 (1) Notwithstanding the other provisions of this chapter, to the extent provided in this
1320 part, the commissioner shall administer and enforce the provisions in this title related to:
1321 (a) title insurance; and
1322 (b) escrow conducted by a title licensee or title insurer.
1323 (2) The commission shall:
1324 (a) in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and
1325 subject to Subsection (3), make rules for the administration of the provisions in this title related
1326 to title insurance including rules related to:
1327 (i) rating standards and rating methods for a title licensee, as provided in Section
1328 31A-19a-209 ;
1329 (ii) the licensing for a title licensee, including the licensing requirements of [Sections

1330 31A-23a-203 and ] Section 31A-23a-204 ;
1331 (iii) continuing education requirements of Section 31A-23a-202 ;
1332 (iv) examination procedures, after consultation with the commissioner and the
1333 commissioner's test administrator when required by Section 31A-23a-204 ; and
1334 (v) standards of conduct for a title licensee;
1335 (b) concur in the issuance and renewal of a license in accordance with Section
1336 31A-23a-105 or 31A-26-203 ;
1337 (c) in accordance with Section 31A-3-103 , establish, with the concurrence of the
1338 commissioner, the fees imposed by this title on a title licensee;
1339 (d) in accordance with Section 31A-23a-415 determine, after consulting with the
1340 commissioner, the assessment on a title insurer as defined in Section 31A-23a-415 ;
1341 (e) conduct an administrative hearing not delegated by the commission to an
1342 administrative law judge related to the:
1343 (i) licensing of an applicant;
1344 (ii) conduct of a title licensee; or
1345 (iii) approval of a continuing education program required by Section 31A-23a-202 ;
1346 (f) with the concurrence of the commissioner, approve a continuing education program
1347 required by Section 31A-23a-202 ;
1348 (g) with the concurrence of the commissioner, impose a penalty:
1349 (i) under this title related to:
1350 (A) title insurance; or
1351 (B) escrow conducted by a title licensee;
1352 (ii) after investigation by the commissioner in accordance with Part 3, Procedures and
1353 Enforcement; and
1354 (iii) that is enforced by the commissioner;
1355 (h) advise the commissioner on the administration and enforcement of any matter
1356 affecting the title insurance industry;
1357 (i) advise the commissioner on matters affecting the commissioner's budget related to
1358 title insurance; and
1359 (j) perform other duties as provided in this title.
1360 (3) The commission may make a rule under this title only if at the time the commission

1361 files its proposed rule and rule analysis with the Division of Administrative Rules in
1362 accordance with Section 63G-3-301 , the commission provides the Real Estate Commission that
1363 same information.
1364 (4) (a) The commissioner shall annually report the information described in Subsection
1365 (4)(b) in writing to:
1366 (i) the commission; and
1367 (ii) the Business and Labor Interim Committee.
1368 (b) The information required to be reported under this Subsection (4):
1369 (i) may not identify a person; and
1370 (ii) shall include:
1371 (A) the number of complaints the commissioner receives with regard to transactions
1372 involving title insurance or a title licensee during the calendar year immediately proceeding the
1373 report;
1374 (B) the type of complaints described in Subsection (4)(b)(ii)(A); and
1375 (C) for each complaint described in Subsection (4)(b)(ii)(A):
1376 (I) any action taken by the commissioner with regard to the complaint; and
1377 (II) the time-period beginning the day on which a complaint is made and ending the
1378 day on which the commissioner determines it will take no further action with regard to the
1379 complaint.
1380 Section 4. Section 31A-22-625 is amended to read:
1381 31A-22-625. Catastrophic coverage of mental health conditions.
1382 (1) As used in this section:
1383 (a) (i) "Catastrophic mental health coverage" means coverage in a health benefit plan
1384 that does not impose a lifetime limit, annual payment limit, episodic limit, inpatient or
1385 outpatient service limit, or maximum out-of-pocket limit that places a greater financial burden
1386 on an insured for the evaluation and treatment of a mental health condition than for the
1387 evaluation and treatment of a physical health condition.
1388 (ii) "Catastrophic mental health coverage" may include a restriction on cost sharing
1389 factors, such as deductibles, copayments, or coinsurance, before reaching a maximum
1390 out-of-pocket limit.
1391 (iii) "Catastrophic mental health coverage" may include one maximum out-of-pocket

1392 limit for physical health conditions and another maximum out-of-pocket limit for mental health
1393 conditions, except that if separate out-of-pocket limits are established, the out-of-pocket limit
1394 for mental health conditions may not exceed the out-of-pocket limit for physical health
1395 conditions.
1396 (b) (i) "50/50 mental health coverage" means coverage in a health benefit plan that
1397 pays for at least 50% of covered services for the diagnosis and treatment of mental health
1398 conditions.
1399 (ii) "50/50 mental health coverage" may include a restriction on:
1400 (A) episodic limits;
1401 (B) inpatient or outpatient service limits; or
1402 (C) maximum out-of-pocket limits.
1403 (c) "Large employer" is as defined in 42 U.S.C. Sec. 300gg-91.
1404 (d) (i) "Mental health condition" means a condition or disorder involving mental illness
1405 that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as
1406 periodically revised.
1407 (ii) "Mental health condition" does not include the following when diagnosed as the
1408 primary or substantial reason or need for treatment:
1409 (A) a marital or family problem;
1410 (B) a social, occupational, religious, or other social maladjustment;
1411 (C) a conduct disorder;
1412 (D) a chronic adjustment disorder;
1413 (E) a psychosexual disorder;
1414 (F) a chronic organic brain syndrome;
1415 (G) a personality disorder;
1416 (H) a specific developmental disorder or learning disability; or
1417 (I) an intellectual disability.
1418 (e) "Small employer" is as defined in 42 U.S.C. Sec. 300gg-91.
1419 (2) (a) At the time of purchase and renewal, an insurer shall offer to a small employer
1420 that it insures or seeks to insure a choice between:
1421 (i) (A) catastrophic mental health coverage; or
1422 (B) federally qualified mental health coverage as described in Subsection (3); and

1423 (ii) 50/50 mental health coverage.
1424 (b) In addition to complying with Subsection (2)(a), an insurer may offer to provide:
1425 (i) catastrophic mental health coverage, 50/50 mental health coverage, or both at levels
1426 that exceed the minimum requirements of this section; or
1427 (ii) coverage that excludes benefits for mental health conditions.
1428 (c) A small employer may, at its option, regardless of the employer's previous coverage
1429 for mental health conditions, choose either:
1430 (i) coverage offered under Subsection (2)(a)(i);
1431 (ii) 50/50 mental health coverage; or
1432 (iii) coverage offered under Subsection (2)(b).
1433 (d) An insurer is exempt from the 30% index rating restriction in Section
1434 31A-30-106.1 and, for the first year only that the employer chooses coverage that meets or
1435 exceeds catastrophic mental health coverage [is chosen], the 15% annual adjustment restriction
1436 in Section 31A-30-106.1 , for any small employer with 20 or less enrolled employees who
1437 chooses coverage that meets or exceeds catastrophic mental health coverage.
1438 (3) An insurer shall offer a large employer mental health and substance use disorder
1439 benefit in compliance with Section 2705 of the Public Health Service Act, 42 U.S.C. Sec.
1440 300gg-26, and federal regulations adopted pursuant to that act.
1441 (4) (a) An insurer may provide catastrophic mental health coverage to a small employer
1442 through a managed care organization or system in a manner consistent with Chapter 8, Health
1443 Maintenance Organizations and Limited Health Plans, regardless of whether the insurance
1444 policy uses a managed care organization or system for the treatment of physical health
1445 conditions.
1446 (b) (i) Notwithstanding any other provision of this title, an insurer may:
1447 (A) establish a closed panel of providers for catastrophic mental health coverage; and
1448 (B) refuse to provide a benefit to be paid for services rendered by a nonpanel provider
1449 unless:
1450 (I) the insured is referred to a nonpanel provider with the prior authorization of the
1451 insurer; and
1452 (II) the nonpanel provider agrees to follow the insurer's protocols and treatment
1453 guidelines.

1454 (ii) If an insured receives services from a nonpanel provider in the manner permitted by
1455 Subsection (4)(b)(i)(B), the insurer shall reimburse the insured for not less than 75% of the
1456 average amount paid by the insurer for comparable services of panel providers under a
1457 noncapitated arrangement who are members of the same class of health care providers.
1458 (iii) This Subsection (4)(b) may not be construed as requiring an insurer to authorize a
1459 referral to a nonpanel provider.
1460 (c) To be eligible for catastrophic mental health coverage, a diagnosis or treatment of a
1461 mental health condition shall be rendered:
1462 (i) by a mental health therapist as defined in Section 58-60-102 ; or
1463 (ii) in a health care facility:
1464 (A) licensed or otherwise authorized to provide mental health services pursuant to:
1465 (I) Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act; or
1466 (II) Title 62A, Chapter 2, Licensure of Programs and Facilities; and
1467 (B) that provides a program for the treatment of a mental health condition pursuant to a
1468 written plan.
1469 (5) The commissioner may prohibit an insurance policy that provides mental health
1470 coverage in a manner that is inconsistent with this section.
1471 (6) The commissioner shall:
1472 (a) adopt rules, in accordance with Title 63G, Chapter 3, Utah Administrative
1473 Rulemaking Act, as necessary to ensure compliance with this section; and
1474 (b) provide general figures on the percentage of insurance policies that include:
1475 (i) no mental health coverage;
1476 (ii) 50/50 mental health coverage;
1477 (iii) catastrophic mental health coverage; and
1478 (iv) coverage that exceeds the minimum requirements of this section.
1479 (7) This section may not be construed as discouraging or otherwise preventing an
1480 insurer from providing mental health coverage in connection with an individual insurance
1481 policy.
1482 Section 5. Section 31A-22-629 is amended to read:
1483 31A-22-629. Adverse benefit determination review process.
1484 (1) As used in this section:

1485 (a) (i) "Adverse benefit determination" means the:
1486 (A) denial of a benefit;
1487 (B) reduction of a benefit;
1488 (C) termination of a benefit; or
1489 (D) failure to provide or make payment, in whole or in part, for a benefit.
1490 (ii) "Adverse benefit determination" includes:
1491 (A) denial, reduction, termination, or failure to provide or make payment that is based
1492 on a determination of an insured's or a beneficiary's eligibility to participate in a plan;
1493 (B) [with respect to individual or group health plans, and income replacement or
1494 disability income policies, a] denial, reduction, or termination of, or a failure to provide or
1495 make payment, in whole or in part, for, a benefit resulting from the application of a utilization
1496 review; [and] or
1497 (C) failure to cover an item or service for which benefits are otherwise provided
1498 because it is determined to be:
1499 (I) experimental;
1500 (II) investigational; or
1501 (III) not medically necessary or appropriate.
1502 (b) "Independent review" means a process that:
1503 (i) is a voluntary option for the resolution of an adverse benefit determination;
1504 (ii) is conducted at the discretion of the claimant;
1505 (iii) is conducted by an independent review organization designated by the insurer;
1506 (iv) renders an independent and impartial decision on an adverse benefit determination
1507 submitted by an insured; and
1508 (v) may not require the insured to pay a fee for requesting the independent review.
1509 (c) "Independent review organization" means a person, subject to Subsection (6), who
1510 conducts an independent external review of adverse determinations.
1511 (d) "Insured" is as defined in Section 31A-1-301 and includes a person who is
1512 authorized to act on the insured's behalf.
1513 (e) "Insurer" is as defined in Section 31A-1-301 and includes:
1514 (i) a health maintenance organization; and
1515 (ii) a third party administrator that offers, sells, manages, or administers a health

1516 insurance policy or health maintenance organization contract that is subject to this title.
1517 (f) "Internal review" means the process an insurer uses to review an insured's adverse
1518 benefit determination before the adverse benefit determination is submitted for independent
1519 review.
1520 (2) This section applies generally to health insurance policies, health maintenance
1521 organization contracts, and income replacement or disability income policies.
1522 (3) (a) An insured may submit an adverse benefit determination to the insurer.
1523 (b) The insurer shall conduct an internal review of the insured's adverse benefit
1524 determination.
1525 (c) An insured who disagrees with the results of an internal review may submit the
1526 adverse benefit determination for an independent review if the adverse benefit determination
1527 involves:
1528 (i) payment of a claim regarding medical necessity; or
1529 (ii) denial of a claim regarding medical necessity.
1530 (4) The commissioner shall adopt rules that establish minimum standards for:
1531 (a) internal reviews;
1532 (b) independent reviews to ensure independence and impartiality;
1533 (c) the types of adverse benefit determinations that may be submitted to an independent
1534 review; and
1535 (d) the timing of the review process, including an expedited review when medically
1536 necessary.
1537 (5) Nothing in this section may be construed as:
1538 (a) expanding, extending, or modifying the terms of a policy or contract with respect to
1539 benefits or coverage;
1540 (b) permitting an insurer to charge an insured for the internal review of an adverse
1541 benefit determination;
1542 (c) restricting the use of arbitration in connection with or subsequent to an independent
1543 review; or
1544 (d) altering the legal rights of any party to seek court or other redress in connection
1545 with:
1546 (i) an adverse decision resulting from an independent review, except that if the insurer

1547 is the party seeking legal redress, the insurer shall pay for the reasonable attorney fees of the
1548 insured related to the action and court costs; or
1549 (ii) an adverse benefit determination or other claim that is not eligible for submission
1550 to independent review.
1551 (6) (a) An independent review organization in relation to the insurer may not be:
1552 (i) the insurer;
1553 (ii) the health plan;
1554 (iii) the health plan's fiduciary;
1555 (iv) the employer; or
1556 (v) an employee or agent of any one listed in Subsections (6)(a)(i) through (iv).
1557 (b) An independent review organization may not have a material professional, familial,
1558 or financial conflict of interest with:
1559 (i) the health plan;
1560 (ii) an officer, director, or management employee of the health plan;
1561 (iii) the enrollee;
1562 (iv) the enrollee's health care provider;
1563 (v) the health care provider's medical group or independent practice association;
1564 (vi) a health care facility where service would be provided; or
1565 (vii) the developer or manufacturer of the service that would be provided.
1566 Section 6. Section 31A-22-635 is amended to read:
1567 31A-22-635. Uniform application -- Uniform waiver of coverage -- Information
1568 on Health Insurance Exchange.
1569 (1) For purposes of this section, "insurer":
1570 (a) is defined in Subsection 31A-22-634 (1); and
1571 (b) includes the state employee's risk pool under Section 49-20-202 .
1572 (2) (a) Insurers offering a health benefit plan to an individual or small employer shall
1573 use a uniform application form.
1574 (b) The uniform application form:
1575 (i) except for cancer and transplants, may not include questions about an applicant's
1576 health history prior to the previous five years; and
1577 (ii) shall be shortened and simplified in accordance with rules adopted by the

1578 commissioner.
1579 (c) Insurers offering a health benefit plan to a small employer shall use a uniform
1580 waiver of coverage form, which may not include health status related questions other than
1581 pregnancy, and is limited to:
1582 (i) information that identifies the employee;
1583 (ii) proof of the employee's insurance coverage; and
1584 (iii) a statement that the employee declines coverage with a particular employer group.
1585 (3) Notwithstanding the requirements of Subsection (2)(a), the uniform application and
1586 uniform waiver of coverage forms may, if the combination or modification is approved by the
1587 commissioner, be combined or modified to facilitate a more efficient and consumer friendly
1588 experience for:
1589 (a) enrollees using the Health Insurance Exchange [if the modification is approved by
1590 the commissioner.]; or
1591 (b) insurers using electronic applications.
1592 (4) The uniform application form, and uniform waiver form, shall be adopted and
1593 approved by the commissioner in accordance with Title 63G, Chapter 3, Utah Administrative
1594 Rulemaking Act.
1595 (5) (a) An insurer who offers a health benefit plan in either the group or individual
1596 market on the Health Insurance Exchange created in Section 63M-1-2504 , shall:
1597 (i) accept and process an electronic submission of the uniform application or uniform
1598 waiver from the Health Insurance Exchange using the electronic standards adopted pursuant to
1599 Section 63M-1-2506 ;
1600 (ii) if requested, provide the applicant with a copy of the completed application either
1601 by mail or electronically;
1602 (iii) post all health benefit plans offered by the insurer in the defined contribution
1603 arrangement market on the Health Insurance Exchange; and
1604 (iv) post the information required by Subsection (6) on the Health Insurance Exchange
1605 for every health benefit plan the insurer offers on the Health Insurance Exchange.
1606 (b) Except as provided in Subsection (5)(c), an insurer who posts health benefit plans
1607 on the Health Insurance Exchange may not directly or indirectly offer products on the Health
1608 Insurance Exchange that are not health benefit plans.

1609 (c) Notwithstanding Subsection (5)(b), an insurer may offer a health savings account
1610 on the Health Insurance Exchange.
1611 (6) An insurer shall provide the commissioner and the Health Insurance Exchange with
1612 the following information for each health benefit plan submitted to the Health Insurance
1613 Exchange, in the electronic format required by Subsection 63M-1-2506 (1):
1614 (a) plan design, benefits, and options offered by the health benefit plan including state
1615 mandates the plan does not cover;
1616 (b) information and Internet address to online provider networks;
1617 (c) wellness programs and incentives;
1618 (d) descriptions of prescription drug benefits, exclusions, or limitations;
1619 (e) the percentage of claims paid by the insurer within 30 days of the date a claim is
1620 submitted to the insurer for the prior year; and
1621 (f) the claims denial and insurer transparency information developed in accordance
1622 with Subsection 31A-22-613.5 (4).
1623 (7) The [Insurance Department] department shall post on the Health Insurance
1624 Exchange the [Insurance Department's] department's solvency rating for each insurer who posts
1625 a health benefit plan on the Health Insurance Exchange. The solvency rating for each insurer
1626 shall be based on methodology established by the [Insurance Department] department by
1627 administrative rule and shall be updated each calendar year.
1628 (8) (a) The commissioner may request information from an insurer under Section
1629 31A-22-613.5 to verify the data submitted to the [Insurance Department] department and to the
1630 Health Insurance Exchange.
1631 (b) The commissioner shall regulate any fees charged by insurers to an enrollee for a
1632 uniform application form or electronic submission of the application forms.
1633 Section 7. Section 31A-23a-101 is amended to read:
1634 31A-23a-101. Purposes.
1635 The purposes of this chapter include:
1636 (1) promoting the professional competence of insurance producers, surplus lines
1637 producers, limited line producers, customer service representatives, consultants, managing
1638 general agents, and reinsurance intermediaries;
1639 (2) providing maximum freedom of marketing methods for insurance, consistent with

1640 the interests of the Utah public;
1641 (3) preserving and encouraging competition at the consumer level;
1642 (4) regulating insurance marketing practices in conformity with the general purposes of
1643 this title;
1644 (5) governing the qualifications and procedures for the licensing of insurance
1645 producers, surplus lines producers, limited line producers, customer service representatives,
1646 consultants, managing general agents, and reinsurance intermediaries; and
1647 (6) promoting uniform licensing requirements between the several states.
1648 Section 8. Section 31A-23a-102 is amended to read:
1649 31A-23a-102. Definitions.
1650 As used in this chapter:
1651 (1) "Bail bond producer" [means a person who:] is as defined in Section 31A-35-102 .
1652 [(a) is appointed by:]
1653 [(i) a surety insurer that issues bail bonds; or]
1654 [(ii) a bail bond surety company licensed under Chapter 35, Bail Bond Act;]
1655 [(b) is designated to execute or countersign undertakings of bail in connection with a
1656 judicial proceeding; and]
1657 [(c) receives or is promised money or other things of value for engaging in an act
1658 described in Subsection (1)(b).]
1659 (2) "Escrow" means a license subline of authority in conjunction with the title
1660 insurance line of authority that allows a person to conduct escrow as defined in Section
1661 31A-1-301 .
1662 (3) "Home state" means a state or territory of the United States or the District of
1663 Columbia in which an insurance producer:
1664 (a) maintains the insurance producer's principal:
1665 (i) place of residence; or
1666 (ii) place of business; and
1667 (b) is licensed to act as an insurance producer.
1668 (4) "Insurer" is as defined in Section 31A-1-301 , except that the following persons or
1669 similar persons are not insurers for purposes of Part 7, Producer Controlled Insurers:
1670 (a) a risk retention group as defined in:

1671 (i) the Superfund Amendments and Reauthorization Act of 1986, Pub. L. No. 99-499;
1672 (ii) the Risk Retention Act, 15 U.S.C. Sec. 3901 et seq.; and
1673 (iii) Chapter 15, Part 2, Risk Retention Groups Act;
1674 (b) a residual market pool;
1675 (c) a joint underwriting authority or association; and
1676 (d) a captive insurer.
1677 (5) "License" is defined in Section 31A-1-301 .
1678 (6) (a) "Managing general agent" means a person that:
1679 (i) manages all or part of the insurance business of an insurer, including the
1680 management of a separate division, department, or underwriting office;
1681 (ii) acts as an agent for the insurer whether it is known as a managing general agent,
1682 manager, or other similar term;
1683 (iii) produces and underwrites an amount of gross direct written premium equal to, or
1684 more than 5% of, the policyholder surplus as reported in the last annual statement of the insurer
1685 in any one quarter or year:
1686 (A) with or without the authority;
1687 (B) separately or together with an affiliate; and
1688 (C) directly or indirectly; and
1689 (iv) (A) adjusts or pays claims in excess of an amount determined by the
1690 commissioner; or
1691 (B) negotiates reinsurance on behalf of the insurer.
1692 (b) Notwithstanding Subsection (6)(a), the following persons may not be considered as
1693 managing general agent for the purposes of this chapter:
1694 (i) an employee of the insurer;
1695 (ii) a United States manager of the United States branch of an alien insurer;
1696 (iii) an underwriting manager that, pursuant to contract:
1697 (A) manages all the insurance operations of the insurer;
1698 (B) is under common control with the insurer;
1699 (C) is subject to Chapter 16, Insurance Holding Companies; and
1700 (D) is not compensated based on the volume of premiums written; and
1701 (iv) the attorney-in-fact authorized by and acting for the subscribers of a reciprocal

1702 insurer or inter-insurance exchange under powers of attorney.
1703 (7) "Negotiate" means the act of conferring directly with or offering advice directly to a
1704 purchaser or prospective purchaser of a particular contract of insurance concerning a
1705 substantive benefit, term, or condition of the contract if the person engaged in that act:
1706 (a) sells insurance; or
1707 (b) obtains insurance from insurers for purchasers.
1708 (8) "Reinsurance intermediary" means:
1709 (a) a reinsurance intermediary-broker; or
1710 (b) a reinsurance intermediary-manager.
1711 (9) "Reinsurance intermediary-broker" means a person other than an officer or
1712 employee of the ceding insurer, firm, association, or corporation who solicits, negotiates, or
1713 places reinsurance cessions or retrocessions on behalf of a ceding insurer without the authority
1714 or power to bind reinsurance on behalf of the insurer.
1715 (10) (a) "Reinsurance intermediary-manager" means a person who:
1716 (i) has authority to bind or who manages all or part of the assumed reinsurance
1717 business of a reinsurer, including the management of a separate division, department, or
1718 underwriting office; and
1719 (ii) acts as an agent for the reinsurer whether the person is known as a reinsurance
1720 intermediary-manager, manager, or other similar term.
1721 (b) Notwithstanding Subsection (10)(a), the following persons may not be considered
1722 reinsurance intermediary-managers for the purpose of this chapter with respect to the reinsurer:
1723 (i) an employee of the reinsurer;
1724 (ii) a United States manager of the United States branch of an alien reinsurer;
1725 (iii) an underwriting manager that, pursuant to contract:
1726 (A) manages all the reinsurance operations of the reinsurer;
1727 (B) is under common control with the reinsurer;
1728 (C) is subject to Chapter 16, Insurance Holding Companies; and
1729 (D) is not compensated based on the volume of premiums written; and
1730 (iv) the manager of a group, association, pool, or organization of insurers that:
1731 (A) engage in joint underwriting or joint reinsurance; and
1732 (B) are subject to examination by the insurance commissioner of the state in which the

1733 manager's principal business office is located.
1734 (11) "Search" means a license subline of authority in conjunction with the title
1735 insurance line of authority that allows a person to issue title insurance commitments or policies
1736 on behalf of a title insurer.
1737 (12) "Sell" means to exchange a contract of insurance:
1738 (a) by any means;
1739 (b) for money or its equivalent; and
1740 (c) on behalf of an insurance company.
1741 (13) "Solicit" means:
1742 (a) attempting to sell insurance;
1743 (b) asking or urging a person to apply for:
1744 (i) a particular kind of insurance; and
1745 (ii) insurance from a particular insurance company;
1746 (c) advertising insurance, including advertising for the purpose of obtaining leads for
1747 the sale of insurance; or
1748 (d) holding oneself out as being in the insurance business.
1749 (14) "Terminate" means:
1750 (a) the cancellation of the relationship between:
1751 (i) an individual licensee or agency licensee and a particular insurer; or
1752 (ii) an individual licensee and a particular agency licensee; or
1753 (b) the termination of:
1754 (i) an individual licensee's or agency licensee's authority to transact insurance on behalf
1755 of a particular insurance company; or
1756 (ii) an individual licensee's authority to transact insurance on behalf of a particular
1757 agency licensee.
1758 (15) "Title marketing representative" means a person who:
1759 (a) represents a title insurer in soliciting, requesting, or negotiating the placing of:
1760 (i) title insurance; or
1761 (ii) escrow services; and
1762 (b) does not have a search or escrow license as provided in Section 31A-23a-106 .
1763 (16) "Uniform application" means the version of the National Association of Insurance

1764 Commissioners' uniform application for resident and nonresident producer licensing at the time
1765 the application is filed.
1766 (17) "Uniform business entity application" means the version of the National
1767 Association of Insurance Commissioners' uniform business entity application for resident and
1768 nonresident business entities at the time the application is filed.
1769 Section 9. Section 31A-23a-103 is amended to read:
1770 31A-23a-103. Requirement of license.
1771 (1) (a) Unless exempted from the licensing requirement under Section 31A-23a-201 or
1772 31A-23a-207 , a person may not perform, offer to perform, or advertise any service as a
1773 producer, surplus lines producer, limited line producer, customer service representative,
1774 consultant, managing general agent, or reinsurance intermediary in Utah, without a valid
1775 individual or agency license issued under this chapter.
1776 (b) A valid license includes at least one license type and one line of authority
1777 pertaining to that license type.
1778 (c) A person may not utilize the services of another as a producer, surplus lines
1779 producer, limited line producer, customer service representative, consultant, managing general
1780 agent, or reinsurance intermediary if that person knows or should know that the other does not
1781 have a license as required by law.
1782 (2) This part may not be construed to require an insurer to obtain an insurance producer
1783 license.
1784 (3) An insurance contract is not invalid as a result of a violation of this section.
1785 Section 10. Section 31A-23a-104 is amended to read:
1786 31A-23a-104. Application for individual license -- Application for agency license.
1787 (1) This section applies to an initial or renewal license as a:
1788 (a) producer;
1789 (b) surplus lines producer;
1790 [(b)] (c) limited line producer;
1791 [(c)] (d) customer service representative;
1792 [(d)] (e) consultant;
1793 [(e)] (f) managing general agent; or
1794 [(f)] (g) reinsurance intermediary.

1795 (2) (a) Subject to Subsection (2)(b), to obtain or renew an individual license, an
1796 individual shall:
1797 (i) file an application for an initial or renewal individual license with the commissioner
1798 on forms and in a manner the commissioner prescribes; and
1799 (ii) pay a license fee that is not refunded if the application:
1800 (A) is denied; or
1801 (B) is incomplete when filed and is never completed by the applicant.
1802 (b) An application described in this Subsection (2) shall provide:
1803 (i) information about the applicant's identity;
1804 (ii) the applicant's Social Security number;
1805 (iii) the applicant's personal history, experience, education, and business record;
1806 (iv) whether the applicant is 18 years of age or older;
1807 (v) whether the applicant has committed an act that is a ground for denial, suspension,
1808 or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ;
1809 (vi) if the application is for a resident individual producer license, certification that the
1810 applicant complies with Section 31A-23a-203.5 ; and
1811 (vii) any other information the commissioner reasonably requires.
1812 (3) The commissioner may require a document reasonably necessary to verify the
1813 information contained in an application filed under this section.
1814 (4) An applicant's Social Security number contained in an application filed under this
1815 section is a private record under Section 63G-2-302 .
1816 (5) (a) Subject to Subsection (5)(b), to obtain or renew an agency license, a person
1817 shall:
1818 (i) file an application for an initial or renewal agency license with the commissioner on
1819 forms and in a manner the commissioner prescribes; and
1820 (ii) pay a license fee that is not refunded if the application:
1821 (A) is denied; or
1822 (B) is incomplete when filed and is never completed by the applicant.
1823 (b) An application described in Subsection (5)(a) shall provide:
1824 (i) information about the applicant's identity;
1825 (ii) the applicant's federal employer identification number;

1826 (iii) the designated responsible licensed producer;
1827 (iv) the identity of [all] the owners, partners, officers, and directors;
1828 (v) whether the applicant has committed an act that is a ground for denial, suspension,
1829 or revocation as set forth in Section 31A-23a-105 or 31A-23a-111 ; and
1830 (vi) any other information the commissioner reasonably requires.
1831 Section 11. Section 31A-23a-105 is amended to read:
1832 31A-23a-105. General requirements for individual and agency license issuance
1833 and renewal.
1834 (1) (a) The commissioner shall issue or renew a license to a person described in
1835 Subsection (1)(b) to act as:
1836 (i) a producer;
1837 (ii) a surplus lines producer;
1838 [(ii)] (iii) a limited line producer;
1839 [(iii)] (iv) a customer service representative;
1840 [(iv)] (v) a consultant;
1841 [(v)] (vi) a managing general agent; or
1842 [(vi)] (vii) a reinsurance intermediary.
1843 (b) The commissioner shall issue or renew a license under Subsection (1)(a) to a
1844 person who, as to the license type and line of authority classification applied for under Section
1845 31A-23a-106 :
1846 (i) satisfies the application requirements under Section 31A-23a-104 ;
1847 (ii) satisfies the character requirements under Section 31A-23a-107 ;
1848 (iii) satisfies any applicable continuing education requirements under Section
1849 31A-23a-202 ;
1850 (iv) satisfies any applicable examination requirements under Section 31A-23a-108 ;
1851 (v) satisfies any applicable training period requirements under Section 31A-23a-203 ;
1852 (vi) if an applicant for a resident individual producer license, certifies that, to the extent
1853 applicable, the applicant:
1854 (A) is in compliance with Section 31A-23a-203.5 ; and
1855 (B) will maintain compliance with Section 31A-23a-203.5 during the period for which
1856 the license is issued or renewed;

1857 (vii) has not committed an act that is a ground for denial, suspension, or revocation as
1858 provided in Section 31A-23a-111 ;
1859 (viii) if a nonresident:
1860 (A) complies with Section 31A-23a-109 ; and
1861 (B) holds an active similar license in that person's state of residence;
1862 (ix) if an applicant for a title insurance producer license, satisfies the requirements of
1863 [Sections 31A-23a-203 and ] Section 31A-23a-204 ;
1864 (x) if an applicant for a license to act as a life settlement provider or life settlement
1865 producer, satisfies the requirements of Section 31A-23a-117 ; and
1866 (xi) pays the applicable fees under Section 31A-3-103 .
1867 (2) (a) This Subsection (2) applies to the following persons:
1868 (i) an applicant for a pending:
1869 (A) individual or agency producer license;
1870 (B) surplus lines producer license;
1871 [(B)] (C) limited line producer license;
1872 [(C)] (D) customer service representative license;
1873 [(D)] (E) consultant license;
1874 [(E)] (F) managing general agent license; or
1875 [(F)] (G) reinsurance intermediary license; or
1876 (ii) a licensed:
1877 (A) individual or agency producer;
1878 (B) surplus lines producer;
1879 [(B)] (C) limited line producer;
1880 [(C)] (D) customer service representative;
1881 [(D)] (E) consultant;
1882 [(E)] (F) managing general agent; or
1883 [(F)] (G) reinsurance intermediary.
1884 (b) A person described in Subsection (2)(a) shall report to the commissioner:
1885 (i) an administrative action taken against the person, including a denial of a new or
1886 renewal license application:
1887 (A) in another jurisdiction; or

1888 (B) by another regulatory agency in this state; and
1889 (ii) a criminal prosecution taken against the person in any jurisdiction.
1890 (c) The report required by Subsection (2)(b) shall:
1891 (i) be filed:
1892 (A) at the time the person files the application for an individual or agency license; and
1893 (B) for an action or prosecution that occurs on or after the day on which the person
1894 files the application:
1895 (I) for an administrative action, within 30 days of the final disposition of the
1896 administrative action; or
1897 (II) for a criminal prosecution, within 30 days of the initial appearance before a court;
1898 and
1899 (ii) include a copy of the complaint or other relevant legal documents related to the
1900 action or prosecution described in Subsection (2)(b).
1901 (3) (a) The department may require a person applying for a license or for consent to
1902 engage in the business of insurance to submit to a criminal background check as a condition of
1903 receiving a license or consent.
1904 (b) A person, if required to submit to a criminal background check under Subsection
1905 (3)(a), shall:
1906 (i) submit a fingerprint card in a form acceptable to the department; and
1907 (ii) consent to a fingerprint background check by:
1908 (A) the Utah Bureau of Criminal Identification; and
1909 (B) the Federal Bureau of Investigation.
1910 (c) For a person who submits a fingerprint card and consents to a fingerprint
1911 background check under Subsection (3)(b), the department may request:
1912 (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
1913 2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
1914 (ii) complete Federal Bureau of Investigation criminal background checks through the
1915 national criminal history system.
1916 (d) Information obtained by the department from the review of criminal history records
1917 received under this Subsection (3) shall be used by the department for the purposes of:
1918 (i) determining if a person satisfies the character requirements under Section

1919 31A-23a-107 for issuance or renewal of a license;
1920 (ii) determining if a person has failed to maintain the character requirements under
1921 Section 31A-23a-107 ; and
1922 (iii) preventing a person who violates the federal Violent Crime Control and Law
1923 Enforcement Act of 1994, 18 U.S.C. Sec. 1033 [and 1034], from engaging in the business of
1924 insurance in the state.
1925 (e) If the department requests the criminal background information, the department
1926 shall:
1927 (i) pay to the Department of Public Safety the costs incurred by the Department of
1928 Public Safety in providing the department criminal background information under Subsection
1929 (3)(c)(i);
1930 (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
1931 of Investigation in providing the department criminal background information under
1932 Subsection (3)(c)(ii); and
1933 (iii) charge the person applying for a license or for consent to engage in the business of
1934 insurance a fee equal to the aggregate of Subsections (3)(e)(i) and (ii).
1935 (4) To become a resident licensee in accordance with Section 31A-23a-104 and this
1936 section, a person licensed as one of the following in another state who moves to this state shall
1937 apply within 90 days of establishing legal residence in this state:
1938 (a) insurance producer;
1939 (b) surplus lines producer;
1940 [(b)] (c) limited line producer;
1941 [(c)] (d) customer service representative;
1942 [(d)] (e) consultant;
1943 [(e)] (f) managing general agent; or
1944 [(f)] (g) reinsurance intermediary.
1945 (5) (a) The commissioner may deny a license application for a license listed in
1946 Subsection (5)(b) if the person applying for the license, as to the license type and line of
1947 authority classification applied for under Section 31A-23a-106 :
1948 (i) fails to satisfy the requirements as set forth in this section; or
1949 (ii) commits an act that is grounds for denial, suspension, or revocation as set forth in

1950 Section 31A-23a-111 .
1951 (b) This Subsection (5) applies to the following licenses:
1952 (i) producer;
1953 (ii) surplus lines producer;
1954 [(ii)] (iii) limited line producer;
1955 [(iii)] (iv) customer service representative;
1956 [(iv)] (v) consultant;
1957 [(v)] (vi) managing general agent; or
1958 [(vi)] (vii) reinsurance intermediary.
1959 (6) Notwithstanding the other provisions of this section, the commissioner may:
1960 (a) issue a license to an applicant for a license for a title insurance line of authority only
1961 with the concurrence of the Title and Escrow Commission; and
1962 (b) renew a license for a title insurance line of authority only with the concurrence of
1963 the Title and Escrow Commission.
1964 Section 12. Section 31A-23a-106 is amended to read:
1965 31A-23a-106. License types.
1966 (1) (a) A resident or nonresident license issued under this chapter shall be issued under
1967 the license types described under Subsection (2).
1968 (b) A license type and a line of authority pertaining to a license type describe the type
1969 of licensee and the lines of business that a licensee may sell, solicit, or negotiate. A license
1970 type is intended to describe the matters to be considered under any education, examination, and
1971 training required of a license applicant under Sections 31A-23a-108 , 31A-23a-202 , and
1972 31A-23a-203 .
1973 (2) (a) A producer license type includes the following lines of authority:
1974 (i) life insurance, including a nonvariable contract;
1975 (ii) variable contracts, including variable life and annuity, if the producer has the life
1976 insurance line of authority;
1977 (iii) accident and health insurance, including a contract issued to a policyholder under
1978 Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance
1979 Organizations and Limited Health Plans;
1980 (iv) property insurance;

1981 (v) casualty insurance, including a surety or other bond;
1982 (vi) title insurance under one or more of the following categories:
1983 (A) search, including authority to act as a title marketing representative;
1984 (B) escrow, including authority to act as a title marketing representative; and
1985 (C) title marketing representative only; and
1986 (vii) personal lines insurance[; and].
1987 [(viii) surplus lines, if the producer has the property or casualty or both lines of
1988 authority.]
1989 (b) A surplus lines producer license type includes the following lines of authority:
1990 (i) property insurance, if the person holds an underlying producer license with the
1991 property line of insurance; and
1992 (ii) casualty insurance, if the person holds an underlying producer license with the
1993 casualty line of authority.
1994 [(b)] (c) A limited line producer license type includes the following limited lines of
1995 authority:
1996 (i) limited line credit insurance;
1997 (ii) travel insurance;
1998 (iii) motor club insurance;
1999 (iv) car rental related insurance;
2000 (v) legal expense insurance;
2001 (vi) crop insurance;
2002 (vii) self-service storage insurance;
2003 (viii) bail bond producer; and
2004 (ix) guaranteed asset protection waiver.
2005 [(c)] (d) A customer service representative license type includes the following lines of
2006 authority, if held by the customer service representative's licensed producer, surplus lines
2007 producer, or consultant employer [producer]:
2008 (i) life insurance, including a nonvariable contract;
2009 (ii) accident and health insurance, including a contract issued to a policyholder under
2010 Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance
2011 Organizations and Limited Health Plans;

2012 (iii) property insurance;
2013 (iv) casualty insurance, including a surety or other bond; and
2014 (v) personal lines insurance[; and].
2015 [(vi) surplus lines, if the employer producer has the property or casualty or both lines of
2016 authority.]
2017 [(d)] (e) A consultant license type includes the following lines of authority:
2018 (i) life insurance, including a nonvariable contract;
2019 (ii) variable contracts, including variable life and annuity, if the consultant has the life
2020 insurance line of authority;
2021 (iii) accident and health insurance, including a contract issued to a policyholder under
2022 Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance
2023 Organizations and Limited Health Plans;
2024 (iv) property insurance;
2025 (v) casualty insurance, including a surety or other bond; and
2026 (vi) personal lines insurance.
2027 [(e)] (f) A managing general agent license type includes the following lines of
2028 authority:
2029 (i) life insurance, including a nonvariable contract;
2030 (ii) variable contracts, including variable life and annuity, if the managing general
2031 agent has the life insurance line of authority;
2032 (iii) accident and health insurance, including a contract issued to a policyholder under
2033 Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance
2034 Organizations and Limited Health Plans;
2035 (iv) property insurance;
2036 (v) casualty insurance, including a surety or other bond; and
2037 (vi) personal lines insurance.
2038 [(f)] (g) A reinsurance intermediary license type includes the following lines of
2039 authority:
2040 (i) life insurance, including a nonvariable contract;
2041 (ii) variable contracts, including variable life and annuity, if the reinsurance
2042 intermediary has the life insurance line of authority;

2043 (iii) accident and health insurance, including a contract issued to a policyholder under
2044 Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance
2045 Organizations and Limited Health Plans;
2046 (iv) property insurance;
2047 (v) casualty insurance, including a surety or other bond; and
2048 (vi) personal lines insurance.
2049 [(g)] (h) A person who holds a license under Subsection (2)(a), [(d),] (e), [or] (f), or (g)
2050 has the qualifications necessary to act as a holder of a license under Subsections (2)[(b) and] (c)
2051 and (d), except that the person may not act under Subsection (2)[(b)](c)(viii) or (ix).
2052 (3) (a) The commissioner may by rule recognize other producer, surplus lines producer,
2053 limited line producer, customer service representative, consultant, managing general agent, or
2054 reinsurance intermediary lines of authority as to kinds of insurance not listed under Subsections
2055 (2)(a) through [(f)] (g).
2056 (b) Notwithstanding Subsection (3)(a), for purposes of title insurance the Title and
2057 Escrow Commission may by rule, with the concurrence of the commissioner and subject to
2058 Section 31A-2-404 , recognize other categories for a title insurance producer line of authority
2059 not listed under Subsection (2)(a)(vi).
2060 (4) The variable contracts[, including variable life and annuity] line of authority
2061 requires:
2062 [(a) licensure as a registered agent or broker by the Financial Industry Regulatory
2063 Authority; and]
2064 [(b) current registration with a securities broker-dealer.]
2065 (a) for a producer,
2066 (i) licensure by the Financial Industry Regulatory Authority as a:
2067 (A) registered securities broker-dealer; or
2068 (B) securities agent; and
2069 (ii) for a securities agent, current registration with a securities broker-dealer; and
2070 (b) for a consultant:
2071 (i) registration with the Securities and Exchange Commission or licensure by the Utah
2072 Division of Securities as a:
2073 (A) securities investment advisor; or

2074 (B) securities investment advisor representative; and
2075 (ii) for a securities investment advisor representative, current association with a
2076 securities investment advisor.
2077 (5) A surplus lines producer is a producer who has a surplus lines [line of authority]
2078 license.
2079 Section 13. Section 31A-23a-107 is amended to read:
2080 31A-23a-107. Character requirements.
2081 [Each] An applicant for a license under this chapter shall show to the commissioner
2082 that:
2083 (1) the applicant has the intent in good faith, to engage in the type of business that the
2084 license applied for would permit;
2085 (2) (a) if a natural person, the applicant is competent and trustworthy; or[,]
2086 (b) if the applicant is an agency[, all];
2087 (i) the partners, directors, or principal officers or persons having comparable powers
2088 are trustworthy[,]; and
2089 (ii) that it will transact business in such a way that [all] the acts that may only be
2090 performed by a licensed producer, surplus lines producer, limited line producer, customer
2091 service representative, consultant, managing general agent, or reinsurance intermediary are
2092 performed exclusively by natural persons who are licensed under this chapter to transact that
2093 type of business and designated on the agency's license;
2094 (3) the applicant intends to comply with Section 31A-23a-502 ; and
2095 (4) if a natural person, the applicant is at least 18 years of age.
2096 Section 14. Section 31A-23a-108 is amended to read:
2097 31A-23a-108. Examination requirements.
2098 (1) (a) The commissioner may require applicants for any particular license type under
2099 Section 31A-23a-106 to pass a line of authority examination as a requirement for a license,
2100 except that an examination may not be required of applicants for:
2101 (i) licenses under Subsections 31A-23a-106 (2)[(b)](c) and [(c)] (d); or
2102 (ii) other limited line license lines of authority recognized by the commissioner or the
2103 Title and Escrow Commission by rule as provided in Subsection 31A-23a-106 (3).
2104 (b) The examination described in Subsection (1)(a):

2105 (i) shall reasonably relate to the line of authority for which it is prescribed; and
2106 (ii) may be administered by the commissioner or as otherwise specified by rule.
2107 (2) The commissioner shall waive the requirement of an examination for a nonresident
2108 applicant who:
2109 (a) applies for an insurance producer license in this state;
2110 (b) has been licensed for the same line of authority in another state; and
2111 (c) (i) is licensed in the state described in Subsection (2)(b) at the time the applicant
2112 applies for an insurance producer license in this state; or
2113 (ii) if the application is received within 90 days of the cancellation of the applicant's
2114 previous license:
2115 (A) the prior state certifies that at the time of cancellation, the applicant was in good
2116 standing in that state; or
2117 (B) the state's producer database records maintained by the National Association of
2118 Insurance Commissioners or the National Association of Insurance Commissioner's affiliates or
2119 subsidiaries, indicates that the producer is or was licensed in good standing for the line of
2120 authority requested.
2121 (3) A nonresident producer licensee who moves to this state and applies for a resident
2122 license within 90 days of establishing legal residence in this state shall be exempt from any line
2123 of authority examination that the producer was authorized on the producer's nonresident
2124 producer license, except where the commissioner determines otherwise by rule.
2125 (4) This section's requirement may only be applied to applicants who are natural
2126 persons.
2127 Section 15. Section 31A-23a-109 is amended to read:
2128 31A-23a-109. Nonresident jurisdictional agreement.
2129 (1) (a) If a nonresident license applicant has a valid producer, surplus lines producer,
2130 limited line producer, customer service representative, consultant, managing general agent, or
2131 reinsurance intermediary license from the nonresident license applicant's home state and the
2132 conditions of Subsection (1)(b) are met, the commissioner shall:
2133 (i) waive [all] the license requirements for a license under this chapter; and
2134 (ii) issue the nonresident license applicant a nonresident license.
2135 (b) Subsection (1)(a) applies if:

2136 (i) the nonresident license applicant:
2137 (A) is licensed as a resident in the nonresident license applicant's home state at the time
2138 the nonresident license applicant applies for a nonresident producer, surplus lines producer,
2139 limited line producer, customer service representative, consultant, managing general agent, or
2140 reinsurance intermediary license;
2141 (B) has submitted the proper request for licensure;
2142 (C) has submitted to the commissioner:
2143 (I) the application for licensure that the nonresident license applicant submitted to the
2144 applicant's home state; or
2145 (II) a completed uniform application; and
2146 (D) has paid the applicable fees under Section 31A-3-103 ; and
2147 (ii) the nonresident license applicant's license in the applicant's home state is in good
2148 standing.
2149 (2) A nonresident applicant applying under Subsection (1) shall in addition to
2150 complying with all license requirements for a license under this chapter execute, in a form
2151 acceptable to the commissioner, an agreement to be subject to the jurisdiction of the Utah
2152 commissioner and courts on any matter related to the applicant's insurance activities in this
2153 state, on the basis of:
2154 (a) service of process under Sections 31A-2-309 and 31A-2-310 ; or
2155 (b) service authorized:
2156 (i) in the Utah Rules of Civil Procedure; or
2157 (ii) under Section 78B-3-206 .
2158 (3) The commissioner may verify a producer's licensing status through the producer
2159 database maintained by:
2160 (a) the National Association of Insurance Commissioners; or
2161 (b) an affiliate or subsidiary of the National Association of Insurance Commissioners.
2162 (4) The commissioner may not assess a greater fee for an insurance license or related
2163 service to a person not residing in this state solely on the fact that the person does not reside in
2164 this state.
2165 Section 16. Section 31A-23a-111 is amended to read:
2166 31A-23a-111. Revocation, suspension, surrender, lapsing, limiting, or otherwise

2167 terminating a license -- Rulemaking for renewal or reinstatement.
2168 (1) A license type issued under this chapter remains in force until:
2169 (a) revoked or suspended under Subsection (5);
2170 (b) surrendered to the commissioner and accepted by the commissioner in lieu of
2171 administrative action;
2172 (c) the licensee dies or is adjudicated incompetent as defined under:
2173 (i) Title 75, Chapter 5, Part 3, Guardians of Incapacitated Persons; or
2174 (ii) Title 75, Chapter 5, Part 4, Protection of Property of Persons Under Disability and
2175 Minors;
2176 (d) lapsed under Section 31A-23a-113 ; or
2177 (e) voluntarily surrendered.
2178 (2) The following may be reinstated within one year after the day on which the license
2179 is no longer in force:
2180 (a) a lapsed license; or
2181 (b) a voluntarily surrendered license, except that a voluntarily surrendered license may
2182 not be reinstated after the license period in which the license is voluntarily surrendered.
2183 (3) Unless otherwise stated in a written agreement for the voluntary surrender of a
2184 license, submission and acceptance of a voluntary surrender of a license does not prevent the
2185 department from pursuing additional disciplinary or other action authorized under:
2186 (a) this title; or
2187 (b) rules made under this title in accordance with Title 63G, Chapter 3, Utah
2188 Administrative Rulemaking Act.
2189 (4) A line of authority issued under this chapter remains in force until:
2190 (a) the qualifications pertaining to a line of authority are no longer met by the licensee;
2191 or
2192 (b) the supporting license type:
2193 (i) is revoked or suspended under Subsection (5);
2194 (ii) is surrendered to the commissioner and accepted by the commissioner in lieu of
2195 administrative action;
2196 [(iii) the licensee dies or is adjudicated incompetent as defined under:]
2197 [(A) Title 75, Chapter 5, Part 3, Guardians of Incapacitated Persons; or]

2198 [(B) Title 75, Chapter 5, Part 4, Protection of Property of Persons Under Disability and
2199 Minors;]
2200 [(iv) lapsed] (iii) lapses under Section 31A-23a-113 ; or
2201 [(v)] (iv) is voluntarily surrendered[.]; or
2202 (c) the licensee dies or is adjudicated incompetent as defined under:
2203 (i) Title 75, Chapter 5, Part 3, Guardians of Incapacitated Persons; or
2204 (ii) Title 75, Chapter 5, Part 4, Protection of Property of Persons Under Disability and
2205 Minors.
2206 (5) (a) If the commissioner makes a finding under Subsection (5)(b), as part of an
2207 adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, the
2208 commissioner may:
2209 (i) revoke:
2210 (A) a license; or
2211 (B) a line of authority;
2212 (ii) suspend for a specified period of 12 months or less:
2213 (A) a license; or
2214 (B) a line of authority;
2215 (iii) limit in whole or in part:
2216 (A) a license; or
2217 (B) a line of authority; or
2218 (iv) deny a license application.
2219 (b) The commissioner may take an action described in Subsection (5)(a) if the
2220 commissioner finds that the licensee:
2221 (i) is unqualified for a license or line of authority under Section 31A-23a-104 ,
2222 31A-23a-105 , or 31A-23a-107 ;
2223 (ii) violates:
2224 (A) an insurance statute;
2225 (B) a rule that is valid under Subsection 31A-2-201 (3); or
2226 (C) an order that is valid under Subsection 31A-2-201 (4);
2227 (iii) is insolvent or the subject of receivership, conservatorship, rehabilitation, or other
2228 delinquency proceedings in any state;

2229 (iv) fails to pay a final judgment rendered against the person in this state within 60
2230 days after the day on which the judgment became final;
2231 (v) fails to meet the same good faith obligations in claims settlement that is required of
2232 admitted insurers;
2233 (vi) is affiliated with and under the same general management or interlocking
2234 directorate or ownership as another insurance producer that transacts business in this state
2235 without a license;
2236 (vii) refuses:
2237 (A) to be examined; or
2238 (B) to produce its accounts, records, and files for examination;
2239 (viii) has an officer who refuses to:
2240 (A) give information with respect to the insurance producer's affairs; or
2241 (B) perform any other legal obligation as to an examination;
2242 (ix) provides information in the license application that is:
2243 (A) incorrect;
2244 (B) misleading;
2245 (C) incomplete; or
2246 (D) materially untrue;
2247 (x) violates an insurance law, valid rule, or valid order of another state's insurance
2248 department;
2249 (xi) obtains or attempts to obtain a license through misrepresentation or fraud;
2250 (xii) improperly withholds, misappropriates, or converts money or properties received
2251 in the course of doing insurance business;
2252 (xiii) intentionally misrepresents the terms of an actual or proposed:
2253 (A) insurance contract;
2254 (B) application for insurance; or
2255 (C) life settlement;
2256 (xiv) is convicted of a felony;
2257 (xv) admits or is found to have committed an insurance unfair trade practice or fraud;
2258 (xvi) in the conduct of business in this state or elsewhere:
2259 (A) uses fraudulent, coercive, or dishonest practices; or

2260 (B) demonstrates incompetence, untrustworthiness, or financial irresponsibility;
2261 (xvii) has an insurance license, or its equivalent, denied, suspended, or revoked in
2262 another state, province, district, or territory;
2263 (xviii) forges another's name to:
2264 (A) an application for insurance; or
2265 (B) a document related to an insurance transaction;
2266 (xix) improperly uses notes or another reference material to complete an examination
2267 for an insurance license;
2268 (xx) knowingly accepts insurance business from an individual who is not licensed;
2269 (xxi) fails to comply with an administrative or court order imposing a child support
2270 obligation;
2271 (xxii) fails to:
2272 (A) pay state income tax; or
2273 (B) comply with an administrative or court order directing payment of state income
2274 tax;
2275 (xxiii) violates or permits others to violate the federal Violent Crime Control and Law
2276 Enforcement Act of 1994, 18 U.S.C. Sec. 1033 [and 1034] and therefore under 18 U.S.C. Sec.
2277 1033 is prohibited from engaging in the business of insurance; or
2278 (xxiv) engages in a method or practice in the conduct of business that endangers the
2279 legitimate interests of customers and the public.
2280 (c) For purposes of this section, if a license is held by an agency, both the agency itself
2281 and any individual designated under the license are considered to be the holders of the license.
2282 (d) If an individual designated under the agency license commits an act or fails to
2283 perform a duty that is a ground for suspending, revoking, or limiting the individual's license,
2284 the commissioner may suspend, revoke, or limit the license of:
2285 (i) the individual;
2286 (ii) the agency, if the agency:
2287 (A) is reckless or negligent in its supervision of the individual; or
2288 (B) knowingly participates in the act or failure to act that is the ground for suspending,
2289 revoking, or limiting the license; or
2290 (iii) (A) the individual; and

2291 (B) the agency if the agency meets the requirements of Subsection (5)(d)(ii).
2292 (6) A licensee under this chapter is subject to the penalties for acting as a licensee
2293 without a license if:
2294 (a) the licensee's license is:
2295 (i) revoked;
2296 (ii) suspended;
2297 (iii) limited;
2298 (iv) surrendered in lieu of administrative action;
2299 (v) lapsed; or
2300 (vi) voluntarily surrendered; and
2301 (b) the licensee:
2302 (i) continues to act as a licensee; or
2303 (ii) violates the terms of the license limitation.
2304 (7) A licensee under this chapter shall immediately report to the commissioner:
2305 (a) a revocation, suspension, or limitation of the person's license in another state, the
2306 District of Columbia, or a territory of the United States;
2307 (b) the imposition of a disciplinary sanction imposed on that person by another state,
2308 the District of Columbia, or a territory of the United States; or
2309 (c) a judgment or injunction entered against that person on the basis of conduct
2310 involving:
2311 (i) fraud;
2312 (ii) deceit;
2313 (iii) misrepresentation; or
2314 (iv) a violation of an insurance law or rule.
2315 (8) (a) An order revoking a license under Subsection (5) or an agreement to surrender a
2316 license in lieu of administrative action may specify a time, not to exceed five years, within
2317 which the former licensee may not apply for a new license.
2318 (b) If no time is specified in an order or agreement described in Subsection (8)(a), the
2319 former licensee may not apply for a new license for five years from the day on which the order
2320 or agreement is made without the express approval by the commissioner.
2321 (9) The commissioner shall promptly withhold, suspend, restrict, or reinstate the use of

2322 a license issued under this part if so ordered by a court.
2323 (10) The commissioner shall by rule prescribe the license renewal and reinstatement
2324 procedures in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
2325 Section 17. Section 31A-23a-113 is amended to read:
2326 31A-23a-113. License lapse and voluntary surrender.
2327 (1) (a) A license issued under this chapter shall lapse if the licensee fails to:
2328 (i) pay when due a fee under Section 31A-3-103 ;
2329 (ii) complete continuing education requirements under Section 31A-23a-202 before
2330 submitting the license renewal application;
2331 (iii) submit a completed renewal application as required by Section 31A-23a-104 ;
2332 (iv) submit additional documentation required to complete the licensing process as
2333 related to a specific license type or line of authority; or
2334 (v) maintain an active license in a resident state if the licensee is a nonresident
2335 licensee.
2336 (b) (i) A licensee whose license lapses due to the following may request an action
2337 described in Subsection (1)(b)(ii):
2338 (A) military service;
2339 (B) voluntary service for a period of time designated by the person for whom the
2340 licensee provides voluntary service; or
2341 (C) some other extenuating circumstances, such as long-term medical disability.
2342 (ii) A licensee described in Subsection (1)(b)(i) may request:
2343 (A) reinstatement of the license no later than one year after the day on which the
2344 license lapses; and
2345 (B) waiver of any of the following imposed for failure to comply with renewal
2346 procedures:
2347 (I) an examination requirement;
2348 (II) reinstatement fees set under Section 31A-3-103 ;
2349 (III) continuing education requirements; or
2350 (IV) other sanction imposed for failure to comply with renewal procedures.
2351 (2) If a license issued under this chapter is voluntarily surrendered, the license or line
2352 of authority may be reinstated:

2353 (a) during the license period in which the license is voluntarily surrendered; and
2354 (b) no later than one year after the day on which the license is voluntarily surrendered.
2355 (3) A voluntarily surrendered license that is reinstated during the license period set
2356 forth in Subsection (2) may not be reinstated until the person who voluntarily surrendered the
2357 license complies with any applicable continuing education requirements for the period during
2358 which the license was voluntarily surrendered.
2359 Section 18. Section 31A-23a-115.5 is amended to read:
2360 31A-23a-115.5. Use of customer service representative.
2361 A customer service representative licensed under this chapter:
2362 (1) may not maintain an office independent of the customer service representative's
2363 licensed producer, surplus lines producer, or consultant employer for the purpose of conducting
2364 insurance activities;
2365 (2) except as provided in Subsection (3), may not sell, solicit, negotiate, or bind
2366 coverage; and
2367 (3) may provide a customer a quote on behalf of the customer service representative's
2368 licensed producer, surplus lines producer, or consultant employer.
2369 Section 19. Section 31A-23a-203 is amended to read:
2370 31A-23a-203. Training period requirements.
2371 (1) A producer is eligible to [add the surplus lines of authority to the person's
2372 producer's license] become a surplus lines producer only if the producer:
2373 (a) has passed the applicable surplus lines producer examination;
2374 (b) has been a producer with property and casualty lines of authority for at least three
2375 years during the four years immediately preceding the date of application; and
2376 (c) has paid the applicable fee under Section 31A-3-103 .
2377 (2) A person is eligible to become a consultant only if the person has acted in a
2378 capacity that would provide the person with preparation to act as an insurance consultant for a
2379 period aggregating not less than three years during the four years immediately preceding the
2380 date of application.
2381 (3) (a) A resident producer with an accident and health line of authority may only sell
2382 long-term care insurance if the producer:
2383 (i) initially completes a minimum of three hours of long-term care training before

2384 selling long-term care coverage; and
2385 (ii) after completing the training required by Subsection (3)(a)(i), completes a
2386 minimum of three hours of long-term care training during each subsequent two-year licensing
2387 period.
2388 (b) A course taken to satisfy a long-term care training requirement may be used toward
2389 satisfying a producer continuing education requirement.
2390 (c) Long-term care training is not a continuing education requirement to renew a
2391 producer license.
2392 (d) An insurer that issues long-term care insurance shall demonstrate to the
2393 commissioner, upon request, that a producer who is appointed by the insurer and who sells
2394 long-term care insurance coverage is in compliance with this Subsection (3).
2395 (4) The training periods required under this section apply only to an individual
2396 applying for a license under this chapter.
2397 Section 20. Section 31A-23a-205 is amended to read:
2398 31A-23a-205. Special requirements for bail bond producers and bail bond
2399 enforcement agents.
2400 (1) As used in this section[, "bail]:
2401 (a) "Bail bond producer" [and "bail] is as defined in Section 31A-35-102 .
2402 (b) "Bail enforcement agent" [have the same definitions as in Section 31A-35-102 ] is
2403 as defined in Section 53-11-102 .
2404 (2) A bail bond producer may not operate in this state without:
2405 (a) an appointment from [one or more] an authorized bail bond surety [insurers or]
2406 insurer and a designation from a licensed bail bond [surety companies.] agency, if the bail bond
2407 producer submits bail bond business through an agency using a surety insurer; or
2408 (b) designation from a licensed bail bond agency, if the bail bond producer submits bail
2409 bond business through an agency using real property or personal property or letter of credit
2410 backing.
2411 (3) A bail bond enforcement agent may [not] only operate in this state [without an
2412 appointment from one or more] through a licensed bail bond [producers] agency.
2413 Section 21. Section 31A-23a-206 is amended to read:
2414 31A-23a-206. Special requirements for variable contracts line of authority.

2415 (1) Before applying for a variable contracts line of authority[,]:
2416 (a) a producer [or consultant] shall be licensed under Section 61-1-3 as a:
2417 [(a)] (i) securities broker-dealer; or
2418 [(b)] (ii) securities agent[.]; and
2419 (b) a consultant shall be licensed under Section 61-1-3 as a:
2420 (i) securities investment advisor; or
2421 (ii) securities investment advisor representative.
2422 (2) A producer's or consultant's variable contracts line of authority is revoked on the day
2423 the producer's or consultant's securities related license under Section 61-1-3 is no longer valid.
2424 Section 22. Section 31A-23a-301 is amended to read:
2425 31A-23a-301. Agency license.
2426 An insurance organization shall be licensed as an agency if the insurance organization
2427 acts as:
2428 (1) a producer;
2429 (2) a surplus lines producer;
2430 [(2)] (3) a limited line producer;
2431 [(3)] (4) a consultant;
2432 [(4)] (5) a managing general agent; or
2433 [(5)] (6) a reinsurance intermediary.
2434 Section 23. Section 31A-23a-302 is amended to read:
2435 31A-23a-302. Agency designations.
2436 (1) An agency shall designate an individual that has an individual producer, surplus
2437 lines producer, limited line producer, customer service representative, consultant, managing
2438 general agent, or reinsurance intermediary license to act on the agency's behalf in order for the
2439 licensee to do business for the agency in this state.
2440 (2) An agency shall report to the commissioner, at intervals and in the form the
2441 commissioner establishes by rule:
2442 (a) a new designation; and
2443 (b) a terminated designation.
2444 (3) (a) An agency licensed under this chapter shall report to the commissioner the
2445 cause of termination of a designation if:

2446 (i) the reason for termination is a reason described in Subsection 31A-23a-111 (5)(b);
2447 or
2448 (ii) the agency has knowledge that the individual licensee is found to have engaged in
2449 an activity described in Subsection 31A-23a-111 (5)(b) by:
2450 (A) a court;
2451 (B) a government body; or
2452 (C) a self-regulatory organization, which the commissioner may define by rule made in
2453 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
2454 (b) The information provided the commissioner under Subsection (3)(a) is a private
2455 record under Title 63G, Chapter 2, Government Records Access and Management Act.
2456 (c) An agency is immune from civil action, civil penalty, or damages if the agency
2457 complies in good faith with this Subsection (3) in reporting to the commissioner the cause of
2458 termination of a designation.
2459 (d) Notwithstanding any other provision in this section, an agency is not immune from
2460 an action or resulting penalty imposed on the reporting agency as a result of proceedings
2461 brought by or on behalf of the department if the action is based on evidence other than the
2462 report submitted in compliance with this Subsection (3).
2463 (4) An agency licensed under this chapter may act in a capacity for which it is licensed
2464 only through an individual who is licensed under this chapter to act in the same capacity.
2465 (5) An agency licensed under this chapter shall designate and report to the
2466 commissioner in accordance with any rule made by the commissioner the name of the
2467 designated responsible licensed individual who has authority to act on behalf of the agency in
2468 [all] the matters pertaining to compliance with this title and orders of the commissioner.
2469 (6) If an agency designates a licensee in reports submitted under Subsection (2) or (5),
2470 there is a rebuttable presumption that the designated licensee acts on behalf of the agency.
2471 (7) (a) When a license is held by an agency, both the agency itself and any individual
2472 designated under the agency license shall be considered to be the holder of the agency license
2473 for purposes of this section.
2474 (b) If an individual designated under the agency license commits an act or fails to
2475 perform a duty that is a ground for suspending, revoking, or limiting the agency license, the
2476 commissioner may suspend, revoke, or limit the license of:

2477 (i) the individual;
2478 (ii) the agency, if the agency:
2479 (A) is reckless or negligent in its supervision of the individual; or
2480 (B) knowingly participates in the act or failure to act that is the ground for suspending,
2481 revoking, or limiting the license; or
2482 (iii) (A) the individual; and
2483 (B) the agency if the agency meets the requirements of Subsection (7)(b)(ii).
2484 Section 24. Section 31A-23a-406 is amended to read:
2485 31A-23a-406. Title insurance producer's business.
2486 (1) A title insurance producer may do escrow involving real property transactions if all
2487 of the following exist:
2488 (a) the title insurance producer is licensed with:
2489 (i) the title line of authority; and
2490 (ii) the escrow subline of authority;
2491 (b) the title insurance producer is appointed by a title insurer authorized to do business
2492 in the state;
2493 (c) the title insurance producer issues one or more of the following as part of the
2494 transaction:
2495 (i) an owner's policy of title insurance; or
2496 (ii) a lender's policy of title insurance;
2497 (d) money deposited with the title insurance producer in connection with any escrow:
2498 (i) is deposited:
2499 (A) in a federally insured financial institution; and
2500 (B) in a trust account that is separate from all other trust account money that is not
2501 related to real estate transactions;
2502 (ii) is the property of the one or more persons entitled to the money under the
2503 provisions of the escrow; and
2504 (iii) is segregated escrow by escrow in the records of the title insurance producer;
2505 (e) earnings on money held in escrow may be paid out of the escrow account to any
2506 person in accordance with the conditions of the escrow;
2507 (f) the escrow does not require the title insurance producer to hold:

2508 (i) construction money; or
2509 (ii) money held for exchange under Section 1031, Internal Revenue Code; and
2510 (g) the title insurance producer shall maintain a physical office in Utah staffed by a
2511 person with an escrow subline of authority who processes the escrow.
2512 (2) Notwithstanding Subsection (1), a title insurance producer may engage in the
2513 escrow business if:
2514 (a) the escrow involves:
2515 (i) a mobile home;
2516 (ii) a grazing right;
2517 (iii) a water right; or
2518 (iv) other personal property authorized by the commissioner; and
2519 (b) the title insurance producer complies with this section except for Subsection (1)(c).
2520 (3) Money held in escrow:
2521 (a) is not subject to any debts of the title insurance producer;
2522 (b) may only be used to fulfill the terms of the individual escrow under which the
2523 money is accepted; and
2524 (c) may not be used until the conditions of the escrow are met.
2525 (4) Assets or property other than escrow money received by a title insurance producer
2526 in accordance with an escrow shall be maintained in a manner that will:
2527 (a) reasonably preserve and protect the asset or property from loss, theft, or damages;
2528 and
2529 (b) otherwise comply with the general duties and responsibilities of a fiduciary or
2530 bailee.
2531 (5) (a) A check from the trust account described in Subsection (1)(d) may not be
2532 drawn, executed, or dated, or money otherwise disbursed unless the segregated escrow account
2533 from which money is to be disbursed contains a sufficient credit balance consisting of collected
2534 and cleared money at the time the check is drawn, executed, or dated, or money is otherwise
2535 disbursed.
2536 (b) As used in this Subsection (5), money is considered to be "collected and cleared,"
2537 and may be disbursed as follows:
2538 (i) cash may be disbursed on the same day the cash is deposited;

2539 (ii) a wire transfer may be disbursed on the same day the wire transfer is deposited; and
2540 (iii) the proceeds of one or more of the following financial instruments may be
2541 disbursed on the same day the financial instruments are deposited if received from a single
2542 party to the real estate transaction and if the aggregate of the financial instruments for the real
2543 estate transaction is less than $10,000:
2544 (A) a cashier's check, certified check, or official check that is drawn on an existing
2545 account at a federally insured financial institution;
2546 (B) a check drawn on the trust account of a principal broker or associate broker
2547 licensed under Title 61, Chapter 2f, Real Estate Licensing and Practices Act, if the title
2548 producer has reasonable and prudent grounds to believe sufficient money will be available
2549 from the trust account on which the check is drawn at the time of disbursement of proceeds
2550 from the title producer's escrow account;
2551 (C) a personal check not to exceed $500 per closing; or
2552 (D) a check drawn on the escrow account of another title producer, if the title producer
2553 in the escrow transaction has reasonable and prudent grounds to believe that sufficient money
2554 will be available for withdrawal from the account upon which the check is drawn at the time of
2555 disbursement of money from the escrow account of the title producer in the escrow
2556 transaction[; or].
2557 [(E) a check issued by a farm credit service authorized under the Farm Credit Act of
2558 1971, 12 U.S.C. Sec. 2001 et seq., as amended.]
2559 (c) [Money received from a financial instrument described in Subsection (5)(b)(iii)(B)
2560 or (C)] A check or deposit not described in Subsection (5)(b) may be disbursed:
2561 (i) within the time limits provided under the Expedited Funds Availability Act, 12
2562 U.S.C. Sec. 4001 et seq., as amended, and related regulations of the Federal Reserve System; or
2563 (ii) upon notification from the financial institution to which the money has been
2564 deposited that final settlement has occurred on the deposited financial instrument.
2565 (6) A title insurance producer shall maintain a record of a receipt or disbursement of
2566 escrow money.
2567 (7) A title insurance producer shall comply with:
2568 (a) Section 31A-23a-409 ;
2569 (b) Title 46, Chapter 1, Notaries Public Reform Act; and

2570 (c) any rules adopted by the Title and Escrow Commission, subject to Section
2571 31A-2-404 , that govern escrows.
2572 (8) If a title insurance producer conducts a search for real estate located in the state, the
2573 title insurance producer shall conduct a minimum mandatory search, as defined by rule made
2574 by the Title and Escrow Commission, subject to Section 31A-2-404 .
2575 Section 25. Section 31A-23a-409 is amended to read:
2576 31A-23a-409. Trust obligation for money collected.
2577 (1) (a) Subject to Subsection (7), a licensee is a trustee for money that is paid to,
2578 received by, or collected by a licensee for forwarding to insurers or to insureds.
2579 (b) (i) Except as provided in Subsection (1)(b)(ii), a licensee may not commingle trust
2580 funds with:
2581 (A) the licensee's own money; or
2582 (B) money held in any other capacity.
2583 (ii) This Subsection (1)(b) does not apply to:
2584 (A) amounts necessary to pay bank charges; and
2585 (B) money paid by insureds and belonging in part to the licensee as a fee or
2586 commission.
2587 (c) Except as provided under Subsection (4), a licensee owes to insureds and insurers
2588 the fiduciary duties of a trustee with respect to money to be forwarded to insurers or insureds
2589 through the licensee.
2590 (d) (i) Unless money is sent to the appropriate payee by the close of the next business
2591 day after their receipt, the licensee shall deposit them in an account authorized under
2592 Subsection (2).
2593 (ii) Money deposited under this Subsection (1)(d) shall remain in an account
2594 authorized under Subsection (2) until sent to the appropriate payee.
2595 (2) Money required to be deposited under Subsection (1) shall be deposited:
2596 (a) in a federally insured trust account in a depository institution, as defined in Section
2597 7-1-103 , which:
2598 (i) has an office in this state, if the licensee depositing the money is a resident licensee;
2599 (ii) has federal deposit insurance; and
2600 (iii) is authorized by its primary regulator to engage in the trust business, as defined by

2601 Section 7-5-1 , in this state; or
2602 (b) in some other account, approved by the commissioner by rule or order, providing
2603 safety comparable to federally insured trust accounts.
2604 (3) It is not a violation of Subsection (2)(a) if the amounts in the accounts exceed the
2605 amount of the federal insurance on the accounts.
2606 (4) A trust account into which money is deposited may be interest bearing. The
2607 interest accrued on the account may be paid to the licensee, so long as the licensee otherwise
2608 complies with this section and with the contract with the insurer.
2609 (5) A depository institution or other organization holding trust funds under this section
2610 may not offset or impound trust account funds against debts and obligations incurred by the
2611 licensee.
2612 (6) A licensee who, not being lawfully entitled to do so, diverts or appropriates any
2613 portion of the money held under Subsection (1) to the licensee's own use, is guilty of theft
2614 under Title 76, Chapter 6, Part 4, Theft. Section 76-6-412 applies in determining the
2615 classification of the offense. Sanctions under Section 31A-2-308 also apply.
2616 (7) A nonresident licensee:
2617 (a) shall comply with Subsection (1)(a) by complying with the trust account
2618 requirements of the nonresident licensee's home state; and
2619 (b) is not required to comply with the other provisions of this section.
2620 Section 26. Section 31A-23a-412 is amended to read:
2621 31A-23a-412. Place of business and residence address -- Records.
2622 (1) (a) A licensee under this chapter shall register and maintain with the commissioner:
2623 (i) the address and telephone numbers of the licensee's principal place of business; and
2624 (ii) a valid business email address at which the commissioner may contact the licensee.
2625 (b) If a licensee is an individual, in addition to complying with Subsection (1)(a) the
2626 individual shall register and maintain with the commissioner the individual's residence address
2627 and telephone number.
2628 (c) A licensee shall notify the commissioner within 30 days of a change of any of the
2629 following required to be registered with the commissioner under this section:
2630 (i) an address;
2631 (ii) a telephone number; or

2632 (iii) a business email address.
2633 (2) (a) Except as provided under Subsection (3), a licensee under this chapter shall
2634 keep at the principal place of business address registered under Subsection (1), separate and
2635 distinct books and records of the transactions consummated under the Utah license.
2636 (b) The books and records described in Subsection (2)(a) shall:
2637 (i) be in an organized form;
2638 (ii) be available to the commissioner for inspection upon reasonable notice; and
2639 (iii) include all of the following:
2640 (A) if the licensee is a producer, surplus lines producer, limited line producer,
2641 consultant, managing general agent, or reinsurance intermediary:
2642 (I) a record of each insurance contract procured by or issued through the licensee, with
2643 the names of insurers and insureds, the amount of premium and commissions or other
2644 compensation, and the subject of the insurance;
2645 (II) the names of any other producers, surplus lines producers, limited line producers,
2646 consultants, managing general agents, or reinsurance intermediaries from whom business is
2647 accepted, and of persons to whom commissions or allowances of any kind are promised or
2648 paid; and
2649 (III) a record of the consumer complaints forwarded to the licensee by an insurance
2650 regulator;
2651 (B) if the licensee is a consultant, a record of each agreement outlining the work
2652 performed and the fee for the work; and
2653 (C) any additional information which:
2654 (I) is customary for a similar business; or
2655 (II) may reasonably be required by the commissioner by rule.
2656 (3) Subsection (2) is satisfied if the books and records specified in Subsection (2) can
2657 be obtained immediately from a central storage place or elsewhere by on-line computer
2658 terminals located at the registered address.
2659 (4) A licensee who represents only a single insurer satisfies Subsection (2) if the
2660 insurer maintains the books and records pursuant to Subsection (2) at a place satisfying
2661 Subsections (1) and (5).
2662 (5) (a) The books and records maintained under Subsection (2) or Section

2663 31A-23a-413 shall be available for the inspection of the commissioner during [all] the business
2664 hours for a period of time after the date of the transaction as specified by the commissioner by
2665 rule, but in no case for less than the current calendar year plus three years.
2666 (b) Discarding books and records after the applicable record retention period has
2667 expired does not place the licensee in violation of a later-adopted longer record retention
2668 period.
2669 Section 27. Section 31A-25-203 is amended to read:
2670 31A-25-203. General requirements for license issuance.
2671 (1) The commissioner shall issue a license to act as a third party administrator to a
2672 person who:
2673 (a) satisfies the character requirements under Section 31A-25-204 ;
2674 (b) satisfies the financial responsibility requirement under Section 31A-25-205 ;
2675 (c) has not committed an act that is a ground for denial, suspension, or revocation
2676 provided in Section 31A-25-208 ;
2677 (d) if a nonresident, complies with Section 31A-25-206 ; and
2678 (e) pays the applicable fees under Section 31A-3-103 .
2679 (2) (a) This Subsection (2) applies to the following persons:
2680 (i) an applicant for a third party administrator's license; or
2681 (ii) a licensed third party administrator.
2682 (b) A person described in Subsection (2)(a) shall report to the commissioner:
2683 (i) an administrative action taken against the person, including a denial of a new or
2684 renewal license application:
2685 (A) in another jurisdiction; or
2686 (B) by another regulatory agency in this state; and
2687 (ii) a criminal prosecution taken against the person in any jurisdiction.
2688 (c) The report required by Subsection (2)(b) shall:
2689 (i) be filed:
2690 (A) at the time the person applies for a third party administrator's license; and
2691 (B) if an action or prosecution occurs on or after the day on which the person applies
2692 for a third party administrator license:
2693 (I) for an administrative action, within 30 days of the final disposition of the

2694 administrative action; or
2695 (II) for a criminal prosecution, within 30 days of the initial appearance before a court;
2696 and
2697 (ii) include a copy of the complaint or other relevant legal documents related to the
2698 action or prosecution described in Subsection (2)(b).
2699 (3) (a) The department may require a person applying for a license or for consent to
2700 engage in the business of insurance to submit to a criminal background check as a condition of
2701 receiving a license or consent.
2702 (b) A person, if required to submit to a criminal background check under Subsection
2703 (3)(a), shall:
2704 (i) submit a fingerprint card in a form acceptable to the department; and
2705 (ii) consent to a fingerprint background check by:
2706 (A) the Utah Bureau of Criminal Identification; and
2707 (B) the Federal Bureau of Investigation.
2708 (c) For a person who submits a fingerprint card and consents to a fingerprint
2709 background check under Subsection (3)(b), the department may request concerning a person
2710 applying for a third party administrator's license:
2711 (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
2712 2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
2713 (ii) complete Federal Bureau of Investigation criminal background checks through the
2714 national criminal history system.
2715 (d) Information obtained by the department from the review of criminal history records
2716 received under this Subsection (3) shall be used by the department for the purposes of:
2717 (i) determining if a person satisfies the character requirements under Section
2718 31A-25-204 for issuance or renewal of a license;
2719 (ii) determining if a person has failed to maintain the character requirements under
2720 Section 31A-25-204 ; and
2721 (iii) preventing a person who violates the federal Violent Crime Control and Law
2722 Enforcement Act of 1994, 18 U.S.C. [Secs.] Sec. 1033 [and 1034], from engaging in the
2723 business of insurance in the state.
2724 (e) If the department requests the criminal background information, the department

2725 shall:
2726 (i) pay to the Department of Public Safety the costs incurred by the Department of
2727 Public Safety in providing the department criminal background information under Subsection
2728 (3)(c)(i);
2729 (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
2730 of Investigation in providing the department criminal background information under
2731 Subsection (3)(c)(ii); and
2732 (iii) charge the person applying for a license or for consent to engage in the business of
2733 insurance a fee equal to the aggregate of Subsections (3)(e)(i) and (ii).
2734 (4) The commissioner may deny a license application to act as a third party
2735 administrator to a person who:
2736 (a) fails to satisfy the requirements of this section; or
2737 (b) commits an act that is a ground for denial, suspension, or revocation provided in
2738 Section 31A-25-208 .
2739 Section 28. Section 31A-25-306 is amended to read:
2740 31A-25-306. Payments by administrator.
2741 [All claims paid by the] An administrator shall pay a claim from [funds] money
2742 collected on behalf of the insurer [shall be paid] on drafts or checks as authorized by the
2743 insurer.
2744 Section 29. Section 31A-26-203 is amended to read:
2745 31A-26-203. Adjuster's license required.
2746 (1) The commissioner shall issue a license to act as an independent adjuster or public
2747 adjuster to a person who, as to the license classification applied for under Section 31A-26-204 :
2748 (a) satisfies the character requirements under Section 31A-26-205 ;
2749 (b) satisfies the applicable continuing education requirements under Section
2750 31A-26-206 ;
2751 (c) satisfies the applicable examination requirements under Section 31A-26-207 ;
2752 (d) has not committed an act that is a ground for denial, suspension, or revocation
2753 provided for in Section 31A-26-213 ;
2754 (e) if a nonresident, complies with Section 31A-26-208 ; and
2755 (f) pays the applicable fees under Section 31A-3-103 .

2756 (2) (a) This Subsection (2) applies to the following persons:
2757 (i) an applicant for:
2758 (A) an independent adjuster's license; or
2759 (B) a public adjuster's license;
2760 (ii) a licensed independent adjuster; or
2761 (iii) a licensed public adjuster.
2762 (b) A person described in Subsection (2)(a) shall report to the commissioner:
2763 (i) an administrative action taken against the person, including a denial of a new or
2764 renewal license application:
2765 (A) in another jurisdiction; or
2766 (B) by another regulatory agency in this state; and
2767 (ii) a criminal prosecution taken against the person in any jurisdiction.
2768 (c) The report required by Subsection (2)(b) shall:
2769 (i) be filed:
2770 (A) at the time the person applies for an adjustor's license; and
2771 (B) if an action or prosecution occurs on or after the day on which the person applies
2772 for an adjustor's license:
2773 (I) for an administrative action, within 30 days of the final disposition of the
2774 administrative action; or
2775 (II) for a criminal prosecution, within 30 days of the initial appearance before a court;
2776 and
2777 (ii) include a copy of the complaint or other relevant legal documents related to the
2778 action or prosecution described in Subsection (2)(b).
2779 (3) (a) The department may require a person applying for a license or for consent to
2780 engage in the business of insurance to submit to a criminal background check as a condition of
2781 receiving a license or consent.
2782 (b) A person, if required to submit to a criminal background check under Subsection
2783 (3)(a), shall:
2784 (i) submit a fingerprint card in a form acceptable to the department; and
2785 (ii) consent to a fingerprint background check by:
2786 (A) the Utah Bureau of Criminal Identification; and

2787 (B) the Federal Bureau of Investigation.
2788 (c) For a person who submits a fingerprint card and consents to a fingerprint
2789 background check under Subsection (3)(b), the department may request concerning a person
2790 applying for an independent or public adjuster's license:
2791 (i) criminal background information maintained pursuant to Title 53, Chapter 10, Part
2792 2, Bureau of Criminal Identification, from the Bureau of Criminal Identification; and
2793 (ii) complete Federal Bureau of Investigation criminal background checks through the
2794 national criminal history system.
2795 (d) Information obtained by the department from the review of criminal history records
2796 received under this Subsection (3) shall be used by the department for the purposes of:
2797 (i) determining if a person satisfies the character requirements under Section
2798 31A-26-205 for issuance or renewal of a license;
2799 (ii) determining if a person has failed to maintain the character requirements under
2800 Section 31A-26-205 ; and
2801 (iii) preventing a person who violates the federal Violent Crime Control and Law
2802 Enforcement Act of 1994, 18 U.S.C. [Secs.] Sec. 1033 [and 1034], from engaging in the
2803 business of insurance in the state.
2804 (e) If the department requests the criminal background information, the department
2805 shall:
2806 (i) pay to the Department of Public Safety the costs incurred by the Department of
2807 Public Safety in providing the department criminal background information under Subsection
2808 (3)(c)(i);
2809 (ii) pay to the Federal Bureau of Investigation the costs incurred by the Federal Bureau
2810 of Investigation in providing the department criminal background information under
2811 Subsection (3)(c)(ii); and
2812 (iii) charge the person applying for a license or for consent to engage in the business of
2813 insurance a fee equal to the aggregate of Subsections (3)(e)(i) and (ii).
2814 (4) The commissioner may deny a license application to act as an independent adjuster
2815 or public adjuster to a person who, as to the license classification applied for under Section
2816 31A-26-204 :
2817 (a) fails to satisfy the requirements in this section; or

2818 (b) commits an act that is a ground for denial, suspension, or revocation provided for in
2819 Section 31A-26-213 .
2820 (5) Notwithstanding the other provisions of this section, the commissioner may:
2821 (a) issue a license to an applicant for a license for a title insurance classification only
2822 with the concurrence of the Title and Escrow Commission; or
2823 (b) renew a license for a title insurance classification only with the concurrence of the
2824 Title and Escrow Commission.
2825 Section 30. Section 31A-27-503 is amended to read:
2826 31A-27-503. Commissioner's administrative actions.
2827 (1) (a) The commissioner may take an action described in Subsection (1)(b) whenever
2828 the commissioner has reasonable cause to believe, and determines after a hearing that an
2829 insurer:
2830 (i) has committed or engaged in an act, practice, or transaction that would subject the
2831 insurer to a formal delinquency proceeding under Chapter 27a, Insurer Receivership Act;
2832 (ii) is committing or engaging in an act, practice, or transaction that would subject the
2833 insurer to a formal delinquency proceeding under Chapter 27a, Insurer Receivership Act;
2834 (iii) is about to commit or engage in an act, practice, or transaction that would subject
2835 the insurer to a formal delinquency proceeding under Chapter 27a, Insurer Receivership Act;
2836 [or]
2837 (iv) is in or is about to be in a condition that would subject the insurer to a formal
2838 delinquency proceeding under Chapter 27a, Insurer Receivership Act[.]; or
2839 (v) is in hazardous financial condition or potentially hazardous financial condition, as
2840 defined by rule made under Subsection 31A-27a-101 (3)(c).
2841 (b) If the conditions of Subsection (1)(a) are met, the commissioner may make and
2842 serve upon the insurer and any other persons whose action or forbearance from action is
2843 reasonably necessary, those orders, other than a seizure order under Section 31A-27a-201 , that
2844 are reasonably necessary to correct, eliminate, or remedy the act, practice, transaction, or
2845 condition described in Subsection (1)(a).
2846 (c) The commissioner may issue an order for the insurer to submit to supervision by a
2847 supervisor appointed by the commissioner until the act, practice, transaction, or condition that
2848 is the ground for the order has been halted or corrected.

2849 (2) (a) The commissioner may make and serve an order issued under Subsection (1)
2850 without notice and before a hearing if:
2851 (i) the conditions of Subsection (1) are satisfied; and
2852 (ii) it appears to the commissioner that irreparable harm to the property or business of
2853 the insurer or to the interests of its policyholders, creditors, or the public may occur unless the
2854 commissioner issues, with immediate effect, the order.
2855 (b) The commissioner shall serve the insurer with an order described in this Subsection
2856 (2) and a notice of agency action, containing a statement of the reasons why irreparable harm is
2857 threatened unless the order is issued with immediate effect.
2858 (3) (a) If the commissioner issues an order for supervision of an insurer under
2859 Subsection (1) or (2), the commissioner shall:
2860 (i) notify the insurer that the insurer is under the supervision of the commissioner; and
2861 (ii) explain the reasons for that supervision.
2862 (b) During the period of supervision, the commissioner may prohibit the insurer from
2863 doing any of the following, without the prior approval of the commissioner or a supervisor
2864 appointed by the commissioner:
2865 (i) transferring any of its assets or its business in force;
2866 (ii) withdrawing funds from any of its bank accounts;
2867 (iii) lending any of its funds;
2868 (iv) investing any of its funds;
2869 (v) transferring any of its property;
2870 (vi) incurring any debt, obligation, or liability other than in the ordinary and usual
2871 course of business; or
2872 (vii) entering into any new reinsurance contract or treaty.
2873 (4) (a) If the commissioner issues a summary order before a hearing under Subsection
2874 (2), the insurer may waive the commissioner's hearing and apply for immediate judicial relief
2875 by any remedy afforded by law, without first exhausting the insurer's administrative remedies.
2876 (b) If the insurer has a hearing before the commissioner, the insurer and any person
2877 whose interests are substantially affected are entitled to judicial review of any order issued by
2878 the commissioner.
2879 Section 31. Section 31A-27a-101 is amended to read:

2880 31A-27a-101. Title -- Construction -- Commissioner's powers.
2881 (1) This chapter is known as the "Insurer Receivership Act."
2882 (2) The proceedings authorized by this chapter may be applied to:
2883 (a) all insurers and reinsurers:
2884 (i) who are doing, or have done, an insurance business in this state; and
2885 (ii) against whom claims arising from that business may exist;
2886 (b) all insurers who have the appearance of or claim they do an insurance business in
2887 this state;
2888 (c) all insurers who have insureds resident in this state; and
2889 (d) all other persons organized or in the process of organizing to do an insurance
2890 business as an insurer in this state.
2891 (3) This chapter shall be liberally construed to protect the interests of insureds,
2892 claimants, creditors, and the public generally through:
2893 (a) early detection of any potentially hazardous condition in an insurer;
2894 (b) prompt application of appropriate corrective measures;
2895 (c) the commissioner making rules pertaining to Subsections (3)(a) and (b):
2896 (i) in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act; and
2897 (ii) that are similar to those set forth in the Model Regulation to Define Standards and
2898 Commissioner's Authority for Companies Deemed to be in Hazardous Financial Condition of
2899 the National Association of Insurance Commissioners;
2900 [(c)] (d) improved methods for conserving and rehabilitating insurers;
2901 [(d)] (e) enhanced efficiency and economy of liquidation, through clarification of the
2902 law, to minimize legal uncertainty and litigation;
2903 [(e)] (f) apportionment of any unavoidable loss in accordance with the statutory
2904 priorities set out in this chapter;
2905 [(f)] (g) lessening the problems of interstate receivership by:
2906 (i) facilitating cooperation among states in delinquency proceedings; and
2907 (ii) extending the scope of personal jurisdiction over debtors of the insurer outside this
2908 state;
2909 [(g)] (h) regulation of the business of insurance by the impact of the law relating to
2910 delinquency procedures and by substantive rules; and

2911 [(h)] (i) providing for a comprehensive scheme for the receivership of insurance
2912 companies and those subject to this chapter as part of the regulation of the business of
2913 insurance in this state.
2914 (4) A proceeding in the case of insurer insolvency and delinquency are integral aspects
2915 of the business of insurance and are of vital public interest and concern.
2916 (5) This chapter does not limit the powers granted the commissioner by other
2917 provisions of law.
2918 (6) [All] The powers and authority of a receiver under this chapter are:
2919 (a) cumulative; and
2920 (b) in addition to any power or authority available to a receiver under a law other than
2921 this chapter.
2922 Section 32. Section 31A-29-112 is amended to read:
2923 31A-29-112. Medicaid recipients.
2924 (1) If authorized by federal statutes or rules, an individual receiving Medicaid benefits
2925 may continue to receive those benefits while satisfying the preexisting condition requirements
2926 established by Section 31A-29-113 and the terms of the pool policy issued under this chapter.
2927 (2) If allowed by federal statute, federal regulation, state statute, or rule, the
2928 Department of Health shall allocate premiums paid to the pool by an individual receiving
2929 Medicaid benefits to that individual's spenddown for purposes of the Medicaid program.
2930 (3) (a) If an individual continues to receive Medicaid benefits after the requirements for
2931 a preexisting condition are satisfied, the pool administrator may not issue a pool policy or
2932 allow that individual to receive any benefit from the pool.
2933 (b) If an individual continues to receive Medicaid benefits when the requirements for a
2934 preexisting condition are satisfied, the pool administrator shall give any premiums collected by
2935 it during the preexisting conditions period to the Medicaid program.
2936 (4) (a) If an enrollee becomes eligible to receive Medicaid benefits, the enrollee's
2937 coverage by the pool terminates as of the effective date of Medicaid coverage.
2938 (b) The pool administrator shall:
2939 (i) include a provision in the pool policy requiring an enrollee to provide written notice
2940 to the pool administration if the enrollee becomes covered by Medicaid; and
2941 (ii) terminate an enrollee's coverage by the pool as of the effective date of the enrollee's

2942 Medicaid coverage when the pool administrator becomes aware that the enrollee is covered by
2943 Medicaid.
2944 (5) If an individual terminates coverage under Medicaid and applies for coverage under
2945 a pool policy within [45] 62 days after terminating the coverage, the individual may begin
2946 coverage under a pool policy as of the date that Medicaid coverage terminated, if an individual
2947 meets the other eligibility requirements of the chapter and pays the required premium.
2948 (6) Notwithstanding Subsections 31A-29-111 (1)(b)(i) and (2)(b)(i), an individual is
2949 eligible for coverage by the pool if the requirements of Section 31A-29-111 are met and if:
2950 (a) the individual's eligibility for Medicaid requires a spenddown, as defined by rule,
2951 that exceeds the premium for a pool policy; or
2952 (b) the individual is eligible for the Primary Care Network program administered by
2953 the Department of Health.
2954 Section 33. Section 31A-30-103 is amended to read:
2955 31A-30-103. Definitions.
2956 As used in this chapter:
2957 (1) "Actuarial certification" means a written statement by a member of the American
2958 Academy of Actuaries or other individual approved by the commissioner that a covered carrier
2959 is in compliance with Sections 31A-30-106 and 31A-30-106.1 , based upon the examination of
2960 the covered carrier, including review of the appropriate records and of the actuarial
2961 assumptions and methods used by the covered carrier in establishing premium rates for
2962 applicable health benefit plans.
2963 (2) "Affiliate" or "affiliated" means any entity or person who directly or indirectly
2964 through one or more intermediaries, controls or is controlled by, or is under common control
2965 with, a specified entity or person.
2966 (3) "Base premium rate" means, for each class of business as to a rating period, the
2967 lowest premium rate charged or that could have been charged under a rating system for that
2968 class of business by the covered carrier to covered insureds with similar case characteristics for
2969 health benefit plans with the same or similar coverage.
2970 [(4) "Basic benefit plan" or "basic coverage" means a health benefit plan that:]
2971 [(a) until January 1, 2012:]
2972 [(i) is a federally qualified high deductible health plan;]

2973 [(ii) has a deductible that has the lowest deductible that qualifies as a federally
2974 qualified high deductible health plan as adjusted by federal law; and]
2975 [(iii) does not exceed an annual out-of-pocket maximum equal to three times the
2976 amount of the deductible; and]
2977 [(b) on or after January 1, 2012, is actuarially equivalent to the NetCare plan with the
2978 highest actuarial value, as provided in Section 31A-22-724 .]
2979 [(5)] (4) "Carrier" means any person or entity that provides health insurance in this
2980 state including:
2981 (a) an insurance company;
2982 (b) a prepaid hospital or medical care plan;
2983 (c) a health maintenance organization;
2984 (d) a multiple employer welfare arrangement; and
2985 (e) any other person or entity providing a health insurance plan under this title.
2986 [(6)] (5) (a) Except as provided in Subsection [(6)] (5)(b), "case characteristics" means
2987 demographic or other objective characteristics of a covered insured that are considered by the
2988 carrier in determining premium rates for the covered insured.
2989 (b) "Case characteristics" do not include:
2990 (i) duration of coverage since the policy was issued;
2991 (ii) claim experience; and
2992 (iii) health status.
2993 [(7)] (6) "Class of business" means all or a separate grouping of covered insureds that
2994 is permitted by the commissioner in accordance with Section 31A-30-105 .
2995 [(8)] (7) "Conversion policy" means a policy providing coverage under the conversion
2996 provisions required in Chapter 22, Part 7, Group Accident and Health Insurance.
2997 [(9)] (8) "Covered carrier" means any individual carrier or small employer carrier
2998 subject to this chapter.
2999 [(10)] (9) "Covered individual" means any individual who is covered under a health
3000 benefit plan subject to this chapter.
3001 [(11)] (10) "Covered insureds" means small employers and individuals who are issued
3002 a health benefit plan that is subject to this chapter.
3003 [(12)] (11) "Dependent" means an individual to the extent that the individual is defined

3004 to be a dependent by:
3005 (a) the health benefit plan covering the covered individual; and
3006 (b) Chapter 22, Part 6, Accident and Health Insurance.
3007 [(13)] (12) "Established geographic service area" means a geographical area approved
3008 by the commissioner within which the carrier is authorized to provide coverage.
3009 [(14)] (13) "Index rate" means, for each class of business as to a rating period for
3010 covered insureds with similar case characteristics, the arithmetic average of the applicable base
3011 premium rate and the corresponding highest premium rate.
3012 [(15)] (14) "Individual carrier" means a carrier that provides coverage on an individual
3013 basis through a health benefit plan regardless of whether:
3014 (a) coverage is offered through:
3015 (i) an association;
3016 (ii) a trust;
3017 (iii) a discretionary group; or
3018 (iv) other similar groups; or
3019 (b) the policy or contract is situated out-of-state.
3020 [(16)] (15) "Individual conversion policy" means a conversion policy issued to:
3021 (a) an individual; or
3022 (b) an individual with a family.
3023 [(17)] (16) "Individual coverage count" means the number of natural persons covered
3024 under a carrier's health benefit products that are individual policies.
3025 [(18)] (17) "Individual enrollment cap" means the percentage set by the commissioner
3026 in accordance with Section 31A-30-110 .
3027 [(19)] (18) "New business premium rate" means, for each class of business as to a
3028 rating period, the lowest premium rate charged or offered, or that could have been charged or
3029 offered, by the carrier to covered insureds with similar case characteristics for newly issued
3030 health benefit plans with the same or similar coverage.
3031 [(20)] (19) "Premium" means money paid by covered insureds and covered individuals
3032 as a condition of receiving coverage from a covered carrier, including any fees or other
3033 contributions associated with the health benefit plan.
3034 [(21)] (20) (a) "Rating period" means the calendar period for which premium rates

3035 established by a covered carrier are assumed to be in effect, as determined by the carrier.
3036 (b) A covered carrier may not have:
3037 (i) more than one rating period in any calendar month; and
3038 (ii) no more than 12 rating periods in any calendar year.
3039 [(22)] (21) "Resident" means an individual who has resided in this state for at least 12
3040 consecutive months immediately preceding the date of application.
3041 [(23)] (22) "Short-term limited duration insurance" means a health benefit product that:
3042 (a) is not renewable; and
3043 (b) has an expiration date specified in the contract that is less than 364 days after the
3044 date the plan became effective.
3045 [(24)] (23) "Small employer carrier" means a carrier that provides health benefit plans
3046 covering eligible employees of one or more small employers in this state, regardless of
3047 whether:
3048 (a) coverage is offered through:
3049 (i) an association;
3050 (ii) a trust;
3051 (iii) a discretionary group; or
3052 (iv) other similar grouping; or
3053 (b) the policy or contract is situated out-of-state.
3054 [(25)] (24) "Uninsurable" means an individual who:
3055 (a) is eligible for the Comprehensive Health Insurance Pool coverage under the
3056 underwriting criteria established in Subsection 31A-29-111 (5); or
3057 (b) (i) is issued a certificate for coverage under Subsection 31A-30-108 (3); and
3058 (ii) has a condition of health that does not meet consistently applied underwriting
3059 criteria as established by the commissioner in accordance with Subsections 31A-30-106 (1)(g)
3060 and (h) for which coverage the applicant is applying.
3061 [(26)] (25) "Uninsurable percentage" for a given calendar year equals UC/CI where, for
3062 purposes of this formula:
3063 (a) "CI" means the carrier's individual coverage count as of December 31 of the
3064 preceding year; and
3065 (b) "UC" means the number of uninsurable individuals who were issued an individual

3066 policy on or after July 1, 1997.
3067 Section 34. Section 31A-30-109 is amended to read:
3068 31A-30-109. Health benefit plan choices.
3069 (1) An individual carrier who offers individual coverage pursuant to Section
3070 31A-30-108 :
3071 (a) shall offer in the individual market under this chapter[: (i) a choice of coverage that
3072 is at least equal to or greater than basic coverage; and (ii) beginning January 1, 2010,] the Utah
3073 NetCare Plan with the highest actuarial value as described in Subsection 31A-22-724 (2); and
3074 (b) may offer a choice of coverage that:
3075 (i) costs less than or equal to the plan described in Subsection (1)(a)[(ii)]; and
3076 (ii) excludes some or all of the mandates described in Subsection 31A-22-724 (3).
3077 (2) Beginning January 1, 2010, a small employer group carrier who offers small
3078 employer group coverage pursuant to Section 31A-30-108 :
3079 (a) shall offer in the small employer group market under this part[: (i) a choice of
3080 coverage that is at least equal to or greater than basic coverage; and (ii) coverage under] the
3081 Utah NetCare Plan with the highest actuarial value as described in Section 31A-22-724 ; and
3082 (b) may offer in the small employer group market under this part, a choice of coverage
3083 that:
3084 (i) costs less than or equal to the coverage in Subsection (2)(a); and
3085 (ii) excludes some or all of the mandates described in Subsection 31A-22-724 (3).
3086 (3) Nothing in this section limits the number of health benefit plans an insurer may
3087 offer.
3088 Section 35. Section 31A-30-112 is amended to read:
3089 31A-30-112. Employee participation levels.
3090 (1) (a) Except as provided in Subsection (2) and Section 31A-30-206 , a requirement
3091 used by a covered carrier in determining whether to provide coverage to a small employer,
3092 including a requirement for minimum participation of eligible employees and minimum
3093 employer contributions, shall be applied uniformly among all small employers with the same
3094 number of eligible employees applying for coverage or receiving coverage from the covered
3095 carrier.
3096 (b) In addition to applying Subsection 31A-1-301 [(123)] (124), a covered carrier may

3097 require that a small employer have a minimum of two eligible employees to meet participation
3098 requirements.
3099 (2) A covered carrier may not increase a requirement for minimum employee
3100 participation or a requirement for minimum employer contribution applicable to a small
3101 employer at any time after the small employer is accepted for coverage.
3102 Section 36. Section 31A-31-105 is amended to read:
3103 31A-31-105. Immunity.
3104 (1) (a) A person, insurer, or authorized agency is immune from civil action, civil
3105 penalty, or damages when in good faith that person, insurer, or authorized agency:
3106 (i) cooperates with an agency described in Subsection (1)(b);
3107 (ii) furnishes evidence to an agency described in Subsection (1)(b);
3108 (iii) provides information regarding a suspected fraudulent insurance act to an agency
3109 described in Subsection (1)(b);
3110 (iv) receives information regarding a suspected fraudulent insurance act from an
3111 agency described in Subsection (1)(b); or
3112 (v) submits a required report to the department under Section 31A-31-110 .
3113 (b) An agency referred to in Subsection (1)(a) is one or more of the following:
3114 (i) the department or a division of the department;
3115 (ii) a federal, state, or government agency established to detect and prevent insurance
3116 fraud;
3117 (iii) a nonprofit organization established to detect and prevent insurance fraud; or
3118 (iv) an agent, employee, or designee of an agency listed in this Subsection (1)(b).
3119 (2) An insurer, or person employed by an insurer, is immune from civil action, civil
3120 penalty, or damages when in good faith the insurer or person employed by an insurer provides
3121 or shares information with another insurer or insurer's employee in a good faith effort to
3122 discover or prevent a fraudulent insurance act or other criminal conduct.
3123 [(2)] (3) A person, insurer, or authorized agency is immune from civil action, civil
3124 penalty, or damages if that person, insurer, or authorized agency complies in good faith with a
3125 court order to provide evidence or testimony requested by an agency described in Subsection
3126 (1)(b).
3127 [(3)] (4) This section does not abrogate or modify a common law or statutory right,

3128 privilege, or immunity enjoyed by a person.
3129 [(4)] (5) Notwithstanding any other provision in this section, a person, insurer, or
3130 service provider is not immune from civil action, civil penalty or damages under this section if
3131 that person commits the fraudulent insurance act that is the subject of the information.
3132 Section 37. Section 31A-41-301 is amended to read:
3133 31A-41-301. Procedure for making a claim against the fund.
3134 (1) (a) To bring a claim against the fund a person shall notify the department within 30
3135 business days of the day on which the person files an action against a title insurance licensee
3136 alleging the following related to a title insurance transaction:
3137 (i) fraud;
3138 (ii) misrepresentation; or
3139 (iii) deceit.
3140 (b) The notification required by Subsection (1)(a) shall be:
3141 (i) in writing; and
3142 (ii) signed by the person who provides the notice.
3143 (c) Within 30 days of the day on which the department receives a notice under
3144 Subsection (1)(a), the department may intervene in the action described in Subsection (1)(a).
3145 (2) (a) Subject to the other provisions in this section, a person who provides the notice
3146 required under Subsection (1) may maintain a claim against the fund if:
3147 (i) in an action described in Subsection (1), the person obtains a final judgment in a
3148 court of competent jurisdiction in this state against a title insurance licensee;
3149 (ii) all proceedings including appeals related to the final judgment described in
3150 Subsection (2)(a)(i) are at an end; and
3151 (iii) the person files a verified petition in the court where the judgment is entered for an
3152 order directing payment from the fund for the uncollected actual damages included in the
3153 judgment and unpaid.
3154 (b) A court may not direct the payment from the fund of:
3155 (i) punitive damages;
3156 (ii) attorney fees;
3157 (iii) interest; or
3158 (iv) court costs.

3159 (c) Regardless of the number of claimants or parcels of real estate involved in a single
3160 real estate transaction, the liability of the fund may not exceed:
3161 (i) $15,000 for a single real estate transaction; or
3162 (ii) $50,000 for all transactions of a title insurance license.
3163 (d) A person shall:
3164 (i) serve the verified petition required by Subsection (2)(a) on the department; and
3165 (ii) file an affidavit of service with the court.
3166 (3) (a) A court shall conduct a hearing on a petition filed with the court within 30 days
3167 after the day on which the department is served.
3168 (b) The person who files the petition may recover from the fund only if the person
3169 shows all of the following:
3170 (i) the person is not a spouse of the judgment debtor or the personal representative of
3171 the spouse;
3172 (ii) the person complied with this chapter;
3173 (iii) the person has obtained a final judgment in accordance with this section indicating
3174 the amount of the judgment awarded;
3175 (iv) the amount still owing on the judgment at the date of the petition;
3176 (v) [(A)] the person has had a writ of execution issued under the judgment, and the
3177 officer executing the writ has returned showing that:
3178 (A) no property subject to execution in satisfaction of the judgment could be found; or
3179 (B) that the amount realized upon the execution levied against the property of the
3180 judgment debtor is insufficient to satisfy the judgement;
3181 (vi) the person has made reasonable searches and inquiries to ascertain whether the
3182 judgment debtor has any interest in property, real or personal, that may satisfy the judgment;
3183 and
3184 (vii) the person has exercised reasonable diligence to secure payment of the judgment
3185 from the assets of the judgment debtor.
3186 (4) If the person described in Subsection (3) satisfies the court that it is not practicable
3187 for the person to comply with one or more of the requirements in Subsections (3)(b)(v) through
3188 (vii), the court may waive those requirements.
3189 (5) (a) A judgment that is the basis for a claim against the fund may not have been

3190 discharged in bankruptcy.
3191 (b) If a bankruptcy proceeding is still open or is commenced during the pendency of the
3192 claim, the person bringing a claim against the fund shall obtain an order from the bankruptcy
3193 court declaring the judgement and debt to be nondischargeable.
3194 Section 38. Section 31A-42-203 is amended to read:
3195 31A-42-203. Powers and duties of board.
3196 (1) The board shall have the power to:
3197 (a) enter into contracts to carry out the provisions and purposes of this chapter,
3198 including, with the approval of the commissioner, contracts with persons or other organizations
3199 for the performance of administrative functions;
3200 (b) sue or be sued, including taking legal action necessary to implement and enforce
3201 the plan for risk adjustment adopted pursuant to this chapter; and
3202 (c) establish appropriate rate adjustments, underwriting policies, and other actuarial
3203 functions appropriate to the operation of the defined contribution arrangement market in
3204 accordance with Section 31A-42-202 .
3205 (2) (a) The board shall prepare and submit an annual report no later than July 1, each
3206 year to the department for inclusion in the department's annual market report, which shall
3207 include:
3208 (i) the expenses of administration of the risk adjuster for the defined contribution
3209 arrangement market;
3210 (ii) a description of the types of policies sold in the defined contribution arrangement
3211 market;
3212 (iii) the number of insured lives in the defined contribution arrangement market; and
3213 (iv) the number of insured lives in health benefit plans that do not include state
3214 mandates.
3215 (b) The budget for operation of the risk adjuster is subject to the approval of the board.
3216 (c) The administrative budget of the board and the commissioner under this chapter
3217 shall comply with the requirements of Title 63J, Chapter 1, Budgetary Procedures Act, and is
3218 subject to review and approval by the Legislature.
3219 [(3) The board shall report to the Health Reform Task Force and to the Legislative
3220 Management Committee prior to October 1, 2009 and again prior to October 1, 2010

3221 regarding:]
3222 [(a) the board's progress in developing the plan required by this chapter; and]
3223 [(b) the board's progress in:]
3224 [(i) expanding choice of plans in the defined contribution market; and]
3225 [(ii) expanding access to the defined contribution market in the Internet portal for large
3226 employer groups.]




Legislative Review Note
as of 11-17-11 10:26 AM

Office of Legislative Research and General Counsel